'Get an Early Check -- Chrysanthemum Tea'

An Outcome Evaluation of a Multimedia Campaign Promoting HIV Testing Among Men Who Have Sex With Men in Hong Kong

NNM Kwan; AMH Wong; Y Fang; Z Wang


HIV Medicine. 2018;19(5):347-354. 

In This Article

Abstract and Introduction


Objectives 'Get an early check – chrysanthemum tea' was a multimedia campaign promoting HIV testing targeting Chinese–speaking men who have sex with men (MSM) in Hong Kong, China. It ran from October to December 2015. This study was carried out to investigate the level of campaign exposure among Chinese–speaking MSM in Hong Kong and the association between uptake of HIV testing in the last 6 months and campaign exposure.

Methods A cross–sectional survey was conducted 6 months after the campaign was launched. Participants were Hong Kong Chinese–speaking men aged ≥18 years who had had anal or oral sex with at least one man in their lifetime. A total of 153 eligible participants completed the anonymous self–administered questionnaire.

Results Among the participants, 45.8% had been exposed to the campaign and 43.1% had taken up HIV testing in the last 6 months. In multivariate logistic regression analysis, exposure to the campaign [multivariate odds ratio (ORm) 2.55; 95% confidence interval (CI) 1.25, 5.19] and having had anal intercourse with a nonregular sex partner (ORm 2.36; 95% CI 1.05, 5.31) in the last 6 months were significantly associated with uptake of HIV testing in the last 6 months.

Conclusions The campaign had relatively good reach in the target population and may have been useful to encourage them to take up HIV testing. Future campaigns promoting HIV testing among MSM in Hong Kong are still needed. Such programmes should consider making use of viral videos, having a longer project duration and developing culturally sensitive materials for non–Chinese–speaking MSM.


HIV infection among men who have sex with men (MSM) is a serious public health threat, both locally and internationally.[1–5] In Hong Kong, the HIV prevalence increased alarmingly from 4.08% in 2011[6] to 5.85% in 2014.[7] The number of reported cases attributed to MSM also increased, from 46 in 2003 to 378 in 2016 (55% of all reported cases).[8]

HIV testing is one of the four global HIV prevention strategies recently recommended by the World Health Organization (WHO) in 2014.[9] Specifically, the WHO guideline recommends that MSM with high–risk behaviours should take up HIV testing every 6–12 months.[10] The US Centers for Disease Control and Prevention (CDC) further recommends that all sexually active MSM should receive HIV testing every 3–6 months.[11] HIV testing and counselling (HTC) can both detect HIV cases and reduce risk behaviours.[12,13]

HIV testing has become even more important given that recent studies have shown that the use of antiretroviral therapy (ART) is highly efficacious (>90%) in preventing HIV infection under conditions of good adherence.[14] Thus, the WHO guideline (2015) recommended ART to all people living with HIV (PLWH), regardless of their CD4 T–cell level,[15] in order to enhance the impact of treatment as prevention.[14] The 90–90–90 target to control HIV globally by 2020 requires that 90% of PLWH be detected,[16] and therefore high coverage of HIV testing is warranted.[17]

In Hong Kong, user–initiated HTC are offered by nongovernmental organizations (NGOs) and governmental clinics free of charge (e.g. social hygiene clinics in Hong Kong). Services in the private sector (e.g. private clinics, laboratories and other organizations) are also available at various prices. In 2015, only 60.8% of the local MSM had received HIV testing in the past 12 months.[18] It is evident that there is a significant deviation between WHO/US CDC recommendations and what is actually practised. Improvement in HIV testing coverage among MSM in Hong Kong is warranted.

Globally, the three most common barriers to HIV testing among MSM are: (1) fear of receiving an HIV–positive test result,[19–23] mainly because of worries about the negative consequences of HIV infection;[20] (2) perceived stigma and discrimination related to sexual orientation,[24,25] and (3) logistic barriers (e.g. high cost and inconvenient timing and/or location). Local MSM reported similar barriers.[26,27] These barriers were considered when developing the health promotion materials of our campaign.

Ten multimedia campaigns promoting HIV testing targeting MSM were identified by our literature search.[28–37] Campaign exposure among the target audience and the impact on HIV testing behaviours were two important indicators for outcome evaluation of these campaigns.[28–37] The prevalence of having been exposed to the campaign materials among MSM varied from 20% to 33% in Thailand,[37] from 49% to 54% in the UK,[32] and from 45% to 84% in the USA.[31,33,34] A systematic review showed that such campaigns could significantly increase HIV testing uptake among MSM.[38] Outcome evaluation of one UK campaign showed that MSM who had been exposed to the campaign were significantly more likely to have been tested in the last 6 months.[32] However, none of these campaigns was conducted among Chinese MSM.

'Web 2.0' is a recently coined term referring to the web–based technologies and services (e.g. social networking websites) that allow users to interact and collaborate as content creators, rather than there being one–way information flow.[39,40] When enough people are sufficiently interested in a post and share it with their peers, who then share it again with their peers and so on, the information will be disseminated in a viral manner on the social networking sites.[41] The most common examples of this are viral videos that attract millions of views.[41] Viral videos have been successfully used to promote sexual health, such as 'Kicesie's Sex Ed' on YouTube (over 240 million views).[42] Given the wide availability of online live–chat applications and smartphones (96% of the Hong Kong population possess a smartphone),[43] it is possible to make use of viral videos as a means of promoting HIV testing, as they can achieve significant reach in the target audience at relatively low cost.

In this paper, we reported an outcome evaluation of the 'Get an early check – chrysanthemum tea', a multimedia campaign targeting Chinese–speaking MSM in Hong Kong. We used the post–test only design for outcome evaluation. Such an approach has been commonly used to evaluate multimedia health promotion campaigns targeting MSM.[44] We conducted a cross–sectional survey 6 months after initiation of the campaign to investigate the level of campaign exposure among Chinese–speaking MSM in Hong Kong and the association between uptake of HIV testing in the last 6 months and campaign exposure.