A qualitative analysis on health service seeking behaviors among newly diagnosed HIV positive men who have sex with men in China

In China specific HIV/AIDS health services (e.g. Four Free and One Care) have been available since 2004. However knowledge of utilizing these services among Chinese people living with HIV/AIDS (PLWH) remains limited. The aim of this qualitative study was therefore to examine health service seeking behaviors and associated factors from the perspective of newly diagnosed HIV positive men who have sex with men (NHIVMSM). We conducted repeated in-depth interviews with 31 NHIVMSM from January to September 2010 in a southern city in China. Thematic content analysis was performed. These NHIVMSM reported non-uptake of free health services or reluctance in seeking other health care. The results identified multiple barriers towards utilization of health services, in keeping with the constructs of the socio-ecological model utilized. These identified barriers served to explain health-related behaviors reported, including low health literacy, mental and emotional health problems, cognitive dissonance, perceived poor quality of services, economic hardship, refusal of access to services, lack of professional support, and restrictive policies. The results provide culturally derived contextual insights to inform the development of socially effective health prevention and intervention services for HIV positive MSM in contemporary China. These include improving mental health services, capacity building of local CDC and NGOs, reforming a non-discriminating health-care referral system, and advocating for alternative health services and self care strategies.