A mixed methods approach to identifying factors related to voluntary HIV testing among injection drug users in Shanghai, China

SummaryObjectivesInjection drug use is a major route of HIV transmission in China, yet relatively little is known about why so few injection drug users utilize free HIV testing services. This study aimed to examine barriers to HIV testing and voluntary counseling and testing (VCT) service utilization among injection drug users in Shanghai, China.MethodsUtilizing mixed methods, we analyzed data from a survey of 540 compulsory drug abuse treatment patients and data from focus groups with 70 service providers and patients.ResultsOnly 24.4% of patients expressed willingness to be tested for HIV. Willingness to be tested was associated with younger age and more positive attitudes towards condom use. Patients reported several barriers to utilization of voluntary HIV testing services, including lack of information about these services, perceptions of no risk or low-risk for HIV infection, fear of positive results, and the stigma or discrimination that may be experienced by the patient or their family. Having limited skills related to HIV counseling was reported by service providers as the primary barrier to encouraging patients to utilize HIV testing/VCT services.ConclusionsSpecial intervention programs targeting injection drug users, their family members, and service providers may increase HIV testing in China.