How social media is helping gay Chinese men fight HIV

Gay men in China are more likely to take HIV tests if they are shown images and videos from crowdsourced social media campaigns, a group of international researchers has concluded.

HIV infection rates are increasing among sexually active gay men in China, yet testing rates remain relatively low because of a lack of awareness and a fear of coming forward due to the social stigma that still surrounds homosexuality in much of the country, the study found.

But the survey of 1,200 sexually active gay men in eight Chinese cities concluded that they were significantly more likely to do so once they had been exposed to health awareness campaigns that had been developed with the help of local gay communities.

This image to promote HIV testing tells people: "HIV infection does not equal Aids. Don't be afraid. Test for your loved ones." Photo: Handout

Conducted by public health researchers in the southern Chinese city of Guangzhou, the study was published in the medical journal PLOS Medicine on Wednesday.

The study, by UNC Project-China, a public health collaboration between the University of North Carolina and a number of universities and hospitals in the mainland and Hong Kong, recruited participants via Blued, a gay social networking app.

They were divided into four groups and every two weeks between August 2016 and August last year were sent images from previous crowdsourced social media campaigns.

All four groups were found to be more likely to take HIV tests after being exposed to the campaigns.

Among the 1,219 respondents who completed the study, there was an 8.9 per cent increase in HIV testing over the past quarter.

"We found that the crowdsourced intervention was effective in promoting HIV testing, especially in promoting HIV self-testing," said Tang Weiming, one of the lead authors of the study and a professor with the Southern Medical University in China and the University of North Carolina.

Tang estimated that the social media campaigns used in the tests, which dated back to 2013, had been viewed by around 10,000 men, around half of whom had been persuaded to take an HIV test at least once as a result.

The social media campaigns used in the study were crowdsourced by various voluntary groups in different cities with the aim of addressing gay Chinese men's interests and concerns.

This image to promote HIV tests reads: "Take the self-test kits home, safe and easy." Photo: Handout

China's official Aids awareness campaigns started producing material aimed at gay men in 2005 and distributing material to encourage HIV testing.

But these campaigns usually involve little more than posters and leaflets in official disease control centres and Tang said people had complained that this approach had little impact.

"They always said 'our voices are not heard, the intervention is not developed for us'. Then we realised that we need a way to let the community design the intervention for themselves," said Tang.

Conservative attitudes still prevail across much of society, further compounding the reluctance of many gay men to seek information on sexual health.

Homosexual activity was only legalised in 1997 and until 2001 it was still officially classified as a mental illness.

Today gay-themed content is still subject to censorship on social media platforms, with everything from drama series to sexual health campaigns being caught in periodic crackdowns on "obscene" and violent material.

"Gay men in China are reluctant to get tested because they are not engaged in many conventional, top-down programmes, and they fear being outed through the process of testing," said Dr Joseph Tucker, one of the lead authors of the study and a professor at the University of North Carolina.

"Also, some medical [centres] in China do not automatically encourage HIV testing."

This image tells people: "Lock in a health life by using a condom." Photo: Handout

"I found the images and videos interesting and informative, unlike the text-based materials we were shown in the official disease control centre. They are creative and funny," said Sam Ding, a survey participant from Guangzhou.

"It's a good reminder for the community. You become more aware of HIV tests after seeing the images."

Ding said he had previously taken an HIV test, but had not been tested in the three months before he joined the study.

The participants in the study were all aged 16 and above, most whom were under 30. None were known to have HIV and all had had penetrative sexual intercourse with another man at least once.

The respondents came from four cities in Guangdong province " Guangzhou, Shenzhen, Zhuhai, and Jiangmen " and four in Shandong province " Jinan, Qingdao, Yantai, and Jining " where HIV testing services are available from local disease control centres.

A finalists from the 2015 competition, when the campaign was themed "sex and health". Photo: Handout

The overall HIV infection rate in China among those aged between 15 and 49 is around 0.1 per cent, lower than the 0.8 per cent international average, according to recent figures from China's Ministry of Health and the World Health Organisation.

However, infection rates among men under 30 have been increasing, with about 3,000 newly reported cases each year, according to the official Chinese Centre for Disease Control and Prevention.

Wu Zunyou, director of China's National Centre for Aids Control and Prevention, said eight per cent of gay men in China carried the virus, and they accounted for 28 per cent of cases in recent years.

The awareness campaigns used in the study originated in an annual poster contest designed with the help of gay groups based in Beijing, Chengdu and Guangzhou.

The contests featured different themes each year " in 2013 it was "Testing Saves Lives", in 2014 "Sex + Health", and in 2015 a condom promotion.

Finalists were awarded around 5,000 yuan (US$735) in cash, and images and videos from the contests were shared via WeChat and Weibo.

Tang said the researchers were also planning to study social media campaigns to promote the Hepatitis B vaccine and pre-exposure prophylaxis, an antiviral drug that can help stop people contracting HIV.

This article originally appeared on the South China Morning Post (SCMP).

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