Using photovoice to explore HIV self-testing and secondary distribution of HIV self-testing among gay, bisexual and other men who have sex with men in China.

Background Human immunodeficiency virus self-testing (HIVST) has been globally recognized as a useful and reliable strategy to promote HIV testing, especially among marginalized populations. To improve the understanding of HIVST uptake of gay, bisexual and other men who have sex with men (GBMSM) in China, this study aims to qualitatively explore the HIVST uptake experiences among this population. Methods The study employed photovoice methodology, theoretically built on documentary photography and critical consciousness, to explore the experiences of HIVST and secondary distribution among GBMSM in China. Participants created photos and citations, and shared and discussed them in the group. Three focus groups and one follow-up interview were held virtually for each participant who self-identified as gay or bisexual and used a self-test kit before. Results This program recruited 22 participants from throughout China. The findings revealed that perceived discrimination based on sexual minority identity, and HIV-related stigma and fear affected participants' decision to take HIVST and to pass HIVST kits on to others. Participants utilized HIVST on a routine basis, citing sexual health concerns, psychological comfort and a responsibility to their significant others as reasons for doing so. HIVST kit distribution within intimacy, and the significant role of GBMSM-led community-based organizations were found as characteristics of interactions between participants and those who they passed HIVST kit(s) on to. Conclusion In the study, images and narratives were acquired through empowering GBMSM, and promoting their community engagement to underline the necessity for measures and policies on promoting HIVST among this population. Findings also entailed the need to create a more inclusive society for sexual minorities and people living with HIV. Implications for promoting HIVST secondary distribution, and limitations and strengths of the pioneer photovoice study among GBMSM in China were also listed.