Abstract:

 Objective  To assess the barriers and enabling factors of voluntary HIV counseling and testing among injection drug users and their attitudes towards community peer opinion leader-led advocacy in expanding voluntary HIV counseling and testing service in Sichuan Province, China. Methods  Chinese governmental legislation and ]policy documents were reviewed and in-depth interviews were conducted with key informants in Dazhou, Sichuan Province. Results  Gaps between the policies and the practice were significant, as exemplified by the co-existence ofsupportive policy driven by free testing and substantial barriers to accessing voluntary HIV counseling and testing services. Injection drug users and key informants expressed intensive barriers to accessing voluntary HIV counseling and testing, such as fear of disclosure of drug use, fear of positive result, fear of discrimination, fear of punishments from the police, lack of confidentiality, andlow perceived HIV risk. Factors that enabled testing included positive peer orfamily influences, as well as health concerns for self or spouse/sex partners, including worry about mother-to-child transmission. All participants formed a consensus that community peer opinion leader-led advocacy in expanding voluntary HIV counseling and testing services was a feasible approach. Conclusion  Effectiveinterventions are urgently needed to overcome these barriers and improve the uptake of available HIV testing. Community peer opinion leader-led advocacy as a means of expanding voluntary HIV counseling and testing services should be further investigated.

Key words: Injection drug user; Voluntary HIV counseling and testing; Peer opinion leader