Gay and HIV-related stigma and discrimination are major
barriers to accessing HIV prevention services among MSM worldwide. We aimed to
identify modifiable factors that mediate the relationships between gay and
HIV-related stigma and discrimination and HIV testing uptake among Chinese MSM.
We conducted a cross-sectional survey study of 523
HIV-uninfected or unknown MSM in Jiangsu Province, China between November 2013
and January 2014. Multivariable analyses were conducted to examine the
associations among experienced homophobia, HIV stigma, and recent HIV testing.
Causal mediation parametric analyses were conducted to assess whether depression
and social norms mediated hypothesized associations.
Stronger subjective norms toward testing was associated with
higher odds of recent HIV testing while
increasing levels of depression and HIV stigma were both associated with lower
odds of recent testing. There was an indirect relationship (natural indirect
effect) of experienced homophobia on recent testing mediated (35.0%) through depression. Furthermore, there was an indirect
relationship of HIV stigma on recent testing mediated (19.2%) through subjective norms.
Depression and social norms are important mediators of HIV
testing uptake among stigmatized Chinese MSM. Therefore, in addition to
advocacy efforts and policies that address social-level stigma and
discrimination, HIV prevention programs should also address mental health
issues and incorporate community-based approaches to changing social norms
toward HIV testing.
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- 11Department of Epidemiology and Biostatistics & Global Health Sciences, University of California - San Francisco, San Francisco, CA, USA 2Harvard School of Public Health, Boston, MA, USA 3Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 4Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, USA.
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