长沙市男男性行为者异性性行为特征及影响因素分析

目的了解长沙市男男性行为者(MSM)异性性行为的特征、影响因素及其HIV/梅毒感染状况,为制定阻断HIV/性传播疾病向妇女传播的干预措施提供参考。方法采取滚雪球和同伴推动抽样方法,对参加自愿咨询检测服务的MSM进行匿名问卷调查,同时抽取静脉血进行HIV和梅毒血清学检测。结果共调查MSM 604例,15.2%在最近6个月内与女性发生过性行为,其中28.0%发生异性性行为从未使用安全套,坚持每次使用安全套仅31.7%。84.8%MSM最近6个月也发生了同性性行为,6.4%从不使用安全套,56.4%有时使用安全套。最近6个月发生过异性性行为的MSM在异性性行为中安全套使用率低于同性性行为中的使用率(P0.05)。MSM的HIV和梅毒感染率分别为12.9%和7.3%。多因素Logistic回归分析显示,婚姻状况、月收入、性取向、首次性交对象是MSM异性性行为的影响因素(P0.05,P0.01)。结论 MSM有异性性行为者比例较高,且发生异性性行为时安全套使用率较低。应重点加强对已婚、月收入高、性取向为双性恋或异性恋或不确定、首次性交对象为女性的MSM安全性行为干预,以降低HIV/性传播疾病向妇女传播的风险。     

网络社交软件对男男同性性行为人群HIV传播的影响

人免疫缺陷病毒(HIV)感染的防控工作是公共卫生领域的重要课题。在我国性接触传播已经超过经血液传播成为最主要的HIV传播途径,男男同性性行为(MSM)中的HIV感染率上升更为明显。网络社交软件替代同性活动场所成为MSM人群主要的性伴侣寻找方式,进而导致了青年特别是学生MSM人群中HIV感染率逐渐升高。与现场纳入的MSM人群相比,经网络募集的MSM调查对象在教育程度、性行为方式以及HIV知识水平等方面有显著差异。网络工具可进一步完善HIV流行病调查以及HIV防控干预。本文就网络社交软件如何对男男同性性行为人群HIV传播产生影响进行了综述。     

309例男同性恋者艾滋病相关知识、态度、行为的现况调查

目的:了解某城区男同性恋者的人口学特征(年龄、文化、职业)及其艾滋病相关知识、态度、行为特征,为制定该人群艾滋病预防措施提供依据。方法:采用流行病学现况研究方法,用"滚雪球"的方式在"同志"社区中设调查点,以"同志"民间协会组织志愿者,同伴教育推引等多种方法相结合寻找被调查对象。结果:309例被调查对象中,30岁以下者265例,占85.8%;大专及以上学历者187例,占60.5%;政府公务员、事业单位人员187例(60.5%),学生91例(29.4%);96.8%(299例)的被调查对象愿意或非常愿意获得艾滋病防治知识;201例(65.1%)认为自己是男同性恋者(MSM),76例(24.6%)承认双性恋;最近半年有117例(37.9%)与至少3例及以上男性发生过插入性性行为,61例(19.7%)有2例及以上固定男性伴;最近半年肛交时经常使用安全套(>80%)的有140例(45.3%),偶尔使用或从未使用的有34例(11.0%)。结论:被调查地区男同性恋者表现出低龄、较高文化程度、职业收入稳定,性伴多、高危行为发生频次高、安全套使用率低的特点,绝大多数(96.8%)非常愿意或愿意获得艾滋病防治知识,应引起相关部门的高度重视。     

本科男护生就业后生活满意度及其影响因素研究

目的探讨影响男护士生活满意度的相关因素,为管理者稳定男性护士队伍提供依据。方法采用便利抽样法,跟踪随访46名本科男护生毕业后从事护理工作的情况,采用生活满意度评定量表和自行设计的职业态度影响因素问卷进行调查。结果男护生毕业后从事临床护理工作43人(93.48%),调查时仅13人仍在临床护理岗位,离岗率达65.22%;在岗组男护士生活满意度评分和各维度分显著低于非在岗组(P<0.05,P<0.01);影响在岗男护士生活满意度的因素主要为社会偏见及传统观念、爱情婚姻困扰、社会地位低、缺乏职业成就感、工作环境、护理工作价值观念困扰等(P<0.05,P<0.01)。结论在岗男护士生活满意度低及离岗率高,需要从社会到个人、从政策到舆论等多方面努力以改善现状。     

男护生的人际关系状况调查

目的 了解男护生的人际关系状况,为促进男护生心理健康教育提供依据.方法 采用人际关系综合诊断量表对4个省市4所院校的132名男护生、129名男医学生、139名女护生进行调查.结果 36.4%男护生存在人际交往困扰;一年级男护生同异性交往评分显著高于二年级男护生(P<0.05);男护生、男医学生、女护生在与人交谈、待人接物两方面评分比较,差异有统计学意义(P<0.05,P<0.01).结论 男护生的人际交往水平有待提高,尤其在与人交谈、待人接物方面;年级可部分影响男护生的人际交往.护理教育者应注重提高男护生的人际交往能力的教育.     

上海市长宁区男男性行为人群梅毒感染情况及其危险因素分析

目的通过对上海市长宁区男男性行为（MSM）人群梅毒感染情况及其危险因素分析,为有效遏制梅毒等经性传播疾病疫情提供有针对性的干预措施。方法对经上海市长宁区疾病预防控制中心自愿咨询检测（VCT）门诊检测咨询的MSM进行面对面问卷调查,并分析其梅毒感染情况及危险因素。结果自2011年11月至2013年3月共调查符合要求的对象231例。经检测,231例调查对象中梅毒感染者56例,占24．24％,其中现症梅毒感染18例,占7。79％。经问卷调查分析得出尖锐湿疣感染者占7．36％（17／231）;18例现症梅毒感染者中,15例（83．33％）合并感染HIV,2例（11．11％）合并感染尖锐湿疣。经单因素分析发现,不同年龄、婚姻状态、文化程度和性伴情况,其梅毒感染情况不刚,芹异具有统计学意义（P均〈0．05）;经多因素非条件Logistic回归分析结果显示,性伴情况对梅毒感染有显著影响（OR=0．088,95％CI：0．029～0．272）,有偶遇同性性伴的MSM梅毒感染率更高。结论到本区检测咨询的MSM梅毒感染率高,还存在一定比例的性病混合感染,有偶遇同性性伴的MSM梅毒感染率更高。应加大对有偶遇同性性伴的MSM人群的宣传力度,强调坚持每次使用安全套的重要性,树立高度的风险意识,让其克服侥幸心理,从而降低梅毒等经性传播疾病感染率。     

男男性行为者沙眼衣原体和淋病奈瑟菌感染筛查

对淋病患者进行调查发现10%~15%的男性临床无症状[1],而89.1%的咽部感染和61.9%的直肠感染者却没有局部相关症状发生[2]。因此,在临床工作和健康教育中不应忽视直肠淋病及其他无症状淋病。生殖道沙眼衣原体(Chlamydia trachomatis,CT)感染者中,有50%~70%男性无症状,如不及时治疗可引起男性尿道炎、附睾炎等[3-4]。生殖道CT及淋病奈瑟菌(Neisseria gonorrhoeae,NG)感染既可以促使人类免疫缺陷病毒(HIV)传播,又可以增加其易感性,而且症状的隐匿性更增加了感染在人群中传播的几率。由于其特殊性,欧州很多国家都对其进行定期筛查。我国对有高危性行为的男男性接触者(men who have sex with men,MSM)的筛查刻不容缓,本文对2014年1月至2018年12月门诊MSM患者进行CT和NG进行主动筛查,并分析筛查情况、流行病特征,为制定预防与控制措施提供科学依据。     

男泌清胶囊治疗慢性前列腺炎的临床与实验研究

目的 :验证男泌清胶囊 (大黄、水蛭、黄芪等 )治疗慢性前列腺炎的临床疗效及作用机理。　方法 :用男泌清胶囊治疗慢性前列腺炎 76例 ,与用前列康片治疗的 32例作对照 ,观察治疗前后前列腺液等改变情况 ;并用消痔灵制作大鼠前列腺炎病理模型 ,分别用男泌清胶囊及前列康片治疗 ,观察 2种药物用药前后大鼠前列腺病理组织学、血浆内皮素、血栓素B2和 6 酮 前列腺素F1α以及超氧化物歧化酶 (SOD)、IgG、IgA变化。　结果 :男泌清临床治疗组总有效率为 89.4 7% ,对照组为 71.88% (P <0 .0 1)。动物实验显示男泌清胶囊改善大鼠前列腺炎各项指标的作用均明显优于前列康片 (P <0 .0 1)。　结论 :临床及实验研究结果显示男泌清胶囊对慢性前列腺炎有较好治疗效果 ;提示“苦寒解毒、活血化瘀、益气扶正”为治疗慢性前列腺炎之重要治法 ,可明显改善慢性前列腺炎的症状     

男男HIV/AIDS患者自我歧视形成的作用模型研究

目的确立男男HIV/AIDS患者自我歧视形成的作用模型,为自我歧视干预提供依据。方法在北京市2所医院便利选取277例男男HIV/AIDS患者,测量其自我歧视水平、年龄、刻板印象、控制感、信息情绪支持和负性情绪等项目,利用结构方程模型确立这些因素对自我歧视的作用途径,形成模型。结果患者自我歧视评分32.29±7.16,除控制感和信息情绪支持外,年龄、刻板印象和负性情绪均对自我歧视有增强作用,模型可解释自我歧视形成作用的40.90%。结论刻板印象是自我歧视的直接成因之一,控制感和信息情绪支持是自我歧视降低的保护性因素,负性情绪会增加自我歧视的水平并妨碍信息情绪支持。建议在对男男HIV/AIDS患者自我歧视干预中提供充分的信息情绪支持以及认知干预,改善患者的刻板印象和负性情绪,降低其自我歧视。     

基于半结构化访谈法分析未成年及成年器官捐献者家属决策影响因素

目的分析公民逝世后未成年及成年器官捐献者家属决策影响因素。方法采用半结构化访谈法访谈15例未成年捐献者和15例成年捐献者直系亲属,使用扎根理论分析访谈记录,分析归纳器官捐献者家属决策影响因素。结果扎根理论分析访谈结果显示,主要有6大类因素影响器官捐献者家属捐献决定:个人因素、器官捐献条件(微环境因素)、社会环境、人际因素、伦理因素和传统观念。中国传统殡葬观念(未成人不得入祖坟)对未成年捐献者家属的捐献意愿影响较大(访谈中提及人数/次数为14/8),而对成年捐献者家属影响不大(访谈中提及人数/次数为0/0);另外,相对成年捐献者家属,未成年捐献者家属的"完尸观念"不强烈。结论相比成年捐献者家属,由于未成年捐献者家属受传统殡葬观念(未成人不得入祖坟)的影响而更易接受器官捐献。本研究结果可以辅助政府制定器官捐献相关政策,为器官捐献工作的进一步开展提供理论基础。     

Stigma,access to healthcare,and HIV risks among men who sell sex to men in Nigeria

Introduction : Among men who have sex with men (MSM), men who sell sex (MSS) may be subject to increased sexual behaviour‐related stigma that affects uptake of healthcare and risk of sexually transmitted infections (STIs). The objectives of this study were to characterize stigma, access to care, and prevalence of HIV among MSS in Nigeria. Methods : Respondent‐driven sampling was used to recruit MSM in Abuja and Lagos into the ongoing TRUST/RV368 study, which provides HIV testing and treatment. Detailed behavioural data were collected by trained interviewers. MSS were identified by self‐report of receiving goods or money in exchange for sex with men. Poisson regression with robust error variance was used to explore the impact of sex‐selling on the risk of HIV. Results : From 12 initial seed participants, 1552 men were recruited from March 2013‐March 2016. Of these, 735 (47.4%) reported sex‐selling. Compared to other MSM, MSS were younger (median 22 vs. 24 years, p < 0.001) and more likely to identify as gay/homosexual (42.4% vs. 31.5%, p < 0.001). MSS were more likely to report perceived and experienced stigmas such as healthcare avoidance (27.6% vs. 21.5%, p = 0.005) and verbal harassment (39.2% vs. 26.8%, p < 0.001). Total HIV prevalence was 53.4%. After controlling for other factors, HIV prevalence among MSS was similar to that observed among other MSM (relative risk 0.94 [95% confidence interval 0.84–1.05]). Conclusions : These data highlight increased sexual behaviour‐related stigma affecting MSS, as compared with other MSM, that limits uptake of healthcare services. The distinct characteristics and risks among MSS suggest the need for specific interventions to optimize linkage to HIV prevention and treatment services in Nigeria.     

Factors influencing HIV infection in men who have sex with men in China

To identify risk factors for HIV infection among men who have sex with men (MSM) and to provide a theoretical basis for prevention interventions. Between December 2011 and August 2012, a case–control study was conducted among MSM who underwent voluntary counselling and testing for HIV. Confirmed HIV-positive MSM were included in the case group, and HIV-negative MSM were included in the control group. Information on possible risk factors was collected by a survey questionnaire and a qualitative interview. The results of a conditional logistic regression showed that the following were influencing factors for HIV infection: average monthly income between 2001 and 3000 Yuan (odds ratio (OR)=6.341, 95% CI: 1.714–12.544), only sometimes using condoms when having anal sex with men in the last 6 months (OR=7.601, 95% CI: 1.359–23.083), having HIV-positive sex partners (OR=5.273, 95% CI: 1.572–17.691), rectal trauma with bleeding in the last 6 months (OR=2.947, 95% CI: 1.308–6.638), not using condoms at last sexual encounter (OR=1.278, 95% CI: 1.012–5.595), engaging in commercial sex (OR=5.925, 95% CI: 1.923–13.890) and having more than 16 sex partners in the last 6 months (OR=1.175, 95% CI: 1.021–1.353). These seven factors were the risk factors of HIV infection (OR>1). However, having anal sex less than 10 times in the previous 1 month (OR=0.002, 95% CI: 0.000–0.287) was a protective factor against HIV infection among MSM (OR<1), and insertive (OR=0.116, 95% CI: 0.000–0.236) (OR<1) anal intercourse influenced HIV infection. Interventions should be targeted at MSM whose average monthly income is between 2001 and 3000 Yuan, and who engage in commercial sex. In addition, the importance of using condoms at every sexual encounter should be emphasised in health education, as should the treatment of rectal trauma with bleeding. Finally, MSM should decrease the number of sex partners and frequency of anal sex to decrease the rate of HIV infection.     

Condom use and HIV testing among men who have sex with men in Jordan

Introduction

To identify sociocultural determinants of self-reported condom use and HIV testing and examine variables related to accessibility, motivation and obstacles among men who have sex with men (MSM) in Jordan.

Design

Cross-sectional study among MSM who were identified through services of a local non-governmental organization (NGO).

Methods

Respondents were studied with a semi-structured interview based on the Explanatory Model Interview Catalogue (EMIC) framework. The vignette-based EMIC interview considered locally relevant HIV/AIDS-related knowledge, risk perception and perceived causes, as well as awareness of services and sources of support.

Results

Of the 97 respondents, 27% reported that they used a condom at last intercourse; 38% had been tested at least once for HIV. Positive determinants of condom use were higher education level, acknowledging MSM as a high-risk group, seeking advice from a medical doctor and the perceived causes “sex with prostitutes” and “sex with animals.” Awareness of available treatment was a positive determinant of HIV testing. Blood transfusion as a perceived cause and asking advice from friends were negative determinants.

Conclusions

Jordanian MSM seem to be aware of the risk of HIV infection and effective prevention methods, and they are willing to be tested for HIV. Our findings addressed the importance of the sexual meaning of HIV/AIDS on the control of HIV/AIDS among MSM. More effective engagement of NGOs and MSM in the prevention and control of HIV/AIDS is needed, enlisting the support of medical doctors and community health workers. Peer education should be strategically strengthened. Political commitment is needed to mitigate social stigma.     

Disclosure of sexual orientation to health professionals in China: results from an online cross‐sectional study

Background : Many men who have sex with men (MSM) in China are “in the closet.” The low rate of disclosure may impact sexual behaviours, testing for HIV and other sexually transmitted infections (STIs), and diseases transmission. This study examines factors associated with overall sexual orientation disclosure and disclosure to healthcare professionals. Methods : A nationwide cross‐sectional online survey was conducted from September 2014 to October 2014 in China. Participants completed questions covering socio‐demographic information, sexual behaviours, HIV/STI testing history, and self‐reported HIV status. We defined healthcare professional disclosure as disclosing to a doctor or other medical provider. Results : A total of 1819 men started the survey and 1424 (78.3%) completed it. Among the 1424 participants, 62.2% (886/1424) reported overall disclosure, and 16.3% (232/1424) disclosed to healthcare professionals. In multivariate analyses, the odds of sexual orientation disclosure were 56% higher among MSM who used smartphone‐based, sex‐seeking applications [adjusted odds ratio (aOR) = 1.56, 95% CI: 1.25–2.95], but were lower among MSM reporting sex while drunk or recreational drug use. The odds of disclosure to a healthcare professional were greater among MSM who had ever tested for HIV or STIs (aOR = 3.36, 95% CI: 2.50–4.51 for HIV, and aOR = 4.92, 95% CI: 3.47–6.96 for STIs, respectively) or self‐reported as living with HIV (aOR = 1.59, 95% CI: 0.93–2.72). Conclusion : Over 80% of MSM had not disclosed their sexual orientation to health professionals. This low level of disclosure likely represents a major obstacle to serving the unique needs of MSM in clinical settings. Further research and interventions to facilitate MSM sexual orientation disclosure, especially to health professionals, are urgently needed.     

Pressured HIV testing “in the name of love”: a mixed methods analysis of pressured HIV testing among men who have sex with men in China

Introduction

HIV testing has rapidly expanded into diverse, decentralized settings. While increasing accessibility to HIV testing is beneficial, it may lead to unintended consequences such as being pressured to test. We examined the frequency, correlates and contexts of pressured HIV testing among Chinese men who have sex with men (MSM) using mixed methods.

Methods

We conducted an online survey of MSM (N = 1044) in May 2017. Pressured HIV testing was defined as being forced to test for HIV. We conducted logistic regression analysis to determine the associations between pressured HIV testing and socio‐demographic and sexual behavioural factors. Follow‐up interviews (n = 17) were conducted with men who reported pressured testing and we analysed qualitative data using a thematic analysis approach.

Results

Ninety‐six men (9.2%) reported experiencing pressure to test for HIV. Regular male sex partners were the most common source of pressure (61%, 59/96), and the most common form of pressure was a threat to end a relationship with the one who was being pressured (39%, 37/96). We found a higher risk of pressured testing in men who had only used HIV self‐testing compared to men who had never self‐tested (AOR 2.39 (95%CI: 1.38 to 4.14)). However, this relationship was only significant among men with low education (AOR 5.88 (95% CI: 1.92 to 17.99)) and not among men with high education (AOR 1.62 (95% CI: 0.85 to 3.10)). After pressured testing, about half of men subsequently tested for HIV (55%, 53/96) without pressure – none reported being diagnosed with HIV. Consistent with this finding, qualitative data suggest that perceptions of pressure existed on a continuum and depended on the relationship status of the one who pressured them. Although being pressured to test was accompanied by negative feelings, men who were pressured into testing often changed their attitude towards HIV testing, testing behaviours, sexual behaviours and relationship with the one who pressured them to test.

Conclusion

Pressured HIV testing was reported among Chinese MSM, especially from men with low education levels and men who received HIV self‐testing. However, in some circumstances, pressure to test helped MSM in several ways, challenging our understanding of the role of agency in the setting of HIV testing.

     

112例艾滋病感染者中男男性行为人群高危行为及心理状况分析

目的：了解艾滋病（AIDS）感染者中男男性行为（MSM）人群高危性行为相关因素和心理状况。方法对112例艾滋病感染者中男男性行为者进行面对面问卷调查,并采集每位调查对象静脉血检测梅毒特异性和非特异性抗体。结果112例调查对象中,梅毒感染所占比例达35.7%（40/112）,其中现症梅毒感染占13.4%（15/112）;安全套使用方面,在知道自己感染艾滋病病毒（HIV）前,安全套“每次都用”所占总比例均低于30.0%;不用安全套原因中,“没有准备安全套”、“对方不愿意使用”和“使用安全套影响双方的亲密感和信任感”所占比例较高,分别为35.7%（40/112）、28.6%（32/112）和25.9%（29/112）;最初知道自己感染HIV后表示“能接受,已经有心理准备”的比例最高,占62.5%（70/112）,“绝望,感觉世界末日到了”的占34.8%（39/112）,“愤怒,决定报复”的占3.6%（4/112）;感受方面感觉有“压力”、“孤独情绪”和“社会歧视”的分别占75.9%（85/112）、58.9%（66/112）和40.2%（45/112）;今后愿意找“感染者”为性伴的比例最高,占61.6%（69/112）;愿意主动告知“值得信赖的人”和“固定同性性伴”自身已感染HIV的占较高比例,分别为67.9%（76/112）和29.5%（33/112）;有66.1%（74/112）受访者表示愿意动员固定同性性伴检测抗-HIV,39.3%（44/112）受访者愿意动员偶遇同性性伴。结论本次回顾性调查发现感染者中梅毒感染率较高,而安全套每次使用率较低,且部分调查对象虽能够理性接受自己感染HIV的事实,但有愤怒、决定报复等负面情绪的感染者也占一定比例。故在今后的工作中,针对感染者和未感染者应分别在心理干预和行为干预方面下功夫,从而有效地遏制艾滋病等经性传播疾病的二代传播。     

HIV self‐testing partially filled the HIV testing gap among men who have sex with men in China during the COVID‐19 pandemic: results from an online survey

IntroductionHIV self‐testing (HIVST) is a useful strategy to promote HIV testing among key populations. This study aimed to understand HIV testing behaviours among men who have sex with men (MSM) and specifically how HIVST was used during the coronavirus disease 2019 (COVID‐19) measures in China when access to facility‐based testing was limited.MethodsAn online cross‐sectional study was conducted to recruit men who have sex with men (MSM) in China from May to June of 2020, a period when COVID‐19 measures were easing. Data on socio‐demographic characteristics, sexual behaviours and HIV testing in the three months before and during COVID‐19 measures (23 January 2020) were collected. Chi‐square test and logistic regression were used for analyses.ResultsOverall, 685 MSM were recruited from 135 cities in 30 provinces of China, whose mean age was 28.8 (SD: 6.9) years old. The majority of participants self‐identified as gay (81.9%) and had disclosed their sexual orientation (66.7%). In the last three months, 69.6% ever had sex with men, nearly half of whom had multiple sexual partners (47.2%). Although the overall HIV testing rates before and during COVID‐19 measures were comparable, more MSM self‐tested for HIV during COVID‐19 measures (52.1%) compared to before COVID‐19 measures (41.6%, p = 0.038). Fewer MSM used facility‐based HIV testing during COVID‐19 measures (42.9%) compared to before COVID‐19 measures (54.1%, p = 0.038). Among 138 facility‐based testers before COVID‐19 measures, 59.4% stopped facility‐based testing during COVID‐19 measures. Among 136 self‐testers during COVID‐19 measures, 58.1% had no HIV self‐testing before COVID‐19 measures. Multivariable logistic regression showed that having sex with other men in the last three months (adjusted odds ratio, aOR = 2.04, 95% CI: 1.38 to 3.03), self‐identifying as gay (aOR = 2.03, 95% CI: 1.31 to 3.13), ever disclosing their sexual orientation (aOR = 1.72, 95% CI: 1.19 to 2.50) and tested for HIV in three months before COVID‐19 measures (aOR = 4.74, 95% CI: 3.35 to 6.70) were associated with HIV testing during COVID‐19 measures.ConclusionsFacility‐based HIV testing decreased and HIVST increased among MSM during COVID‐19 measures in China. MSM successfully accessed HIVST as substitute for facility‐based testing, with no overall decrease in HIV testing rates.     

Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston,Jamaica: a qualitative study

Introduction : Young men who have sex with men (MSM) in Jamaica have the highest HIV prevalence in the Caribbean. There is little information about HIV among transgender women in Jamaica, who are also overrepresented in the Caribbean epidemic. HIV‐related stigma is a barrier to HIV testing among Jamaica's general population, yet little is known of MSM and transgender women's HIV testing experiences in Jamaica. We explored perceived barriers and facilitators to HIV testing among young MSM and transgender women in Kingston, Jamaica. Methods : We implemented a community‐based research project in collaboration with HIV and lesbian, gay, bisexual and transgender (LGBT) agencies in Kingston. We held two focus groups, one with young (aged 18–30 years) transgender women (n = 8) and one with young MSM (n = 10). We conducted 53 in‐depth individual semi‐structured interviews focused on HIV testing experiences with young MSM (n = 20), transgender women (n = 20), and community‐based key informants (n = 13). We conducted thematic analysis to identify, analyze, and report themes. Results : Participant narratives revealed social‐ecological barriers and facilitators to HIV testing. Barriers included healthcare provider mistreatment, confidentiality breaches, and HIV‐related stigma: these spanned interpersonal, community and structural levels. Healthcare provider discrimination and judgment in HIV testing provision presented barriers to accessing HIV services (e.g. treatment), and resulted in participants hiding their sexual orientation and/or gender identity. Confidentiality concerns included: clinic physical arrangements that segregated HIV testing from other health services, fear that healthcare providers would publicly disclose their status, and concerns at LGBT‐friendly clinics that peers would discover they were getting tested. HIV‐related stigma contributed to fear of testing HIV‐positive; this intersected with the stigma of HIV as a “gay” disease. Participants also anticipated healthcare provider mistreatment if they tested HIV positive. Participants identified individual (belief in benefits of knowing one's HIV status), social (social support) and structural (accessible testing) factors that can increase HIV testing uptake. Conclusions : Findings suggest the need for policy and practice changes to enhance confidentiality and reduce discrimination in Jamaica. Interventions to challenge HIV‐related and LGBT stigma in community and healthcare settings can enhance access to the HIV prevention cascade among MSM and transgender youth in Jamaica.