Inequities in willingness to disclose contact information to access free mpox self-testing kits among MSM in China: a...

Free mpox self-testing often requires disclosure of personal contact information (e.g., phone numbers or social media IDs). Among men who have sex with men (MSM), this requirement can function as an access gate with unequal impacts across socioeconomic and regional contexts. Using the Capability, Opportunity, Motivation-Behavior (COM-B) framework, we examined psychosocial and socioeconomic correlates of willingness to disclose among MSM in China.

We conducted an anonymous online cross-sectional survey (November 2023-March 2024) in six provincial regions representing three development tiers. MSM (n = 2,403) were recruited via community-based organizations using snowball sampling. Guided by the COM-B framework, we fitted hierarchical logistic regression models with sequential adjustment for sociodemographic, health, and behavioral covariates to estimate associations with disclosure willingness. Prespecified stratified analyses by education, income, and regional development assessed heterogeneity.

Overall, 57.9% reported willingness to disclose contact information to obtain free mpox self-testing kits. COM-B factors were consistently associated with willingness across models: higher prevention self-efficacy (OR = 1.028, 95% CI: 1.009-1.046) and prior HIV voluntary counseling and testing (VCT) (OR = 1.535, 95% CI: 1.240-1.899) were positively associated with willingness, whereas greater healthcare-related concerns were negatively associated with it (OR = 0.983, 95% CI: 0.975-0.990). College education (OR = 1.542, 95% CI: 1.233-1.928) and higher income (≥ 6,001 CNY: OR = 1.349, 95% CI: 1.003-1.814) were positively associated. Compared with highly developed regions, MSM in moderately developed regions showed lower odds of willingness to disclose (OR = 0.607, 95% CI: 0.491-0.750). Subgroup analyses indicated that social support was more influential in less developed regions, while privacy- and discrimination-related concerns were more salient in moderately developed regions.

Requiring contact disclosure to access free self-testing can create inequitable barriers. Equity-oriented implementation should: (1) strengthen self-efficacy through peer-led practice and prompts; (2) reduce healthcare-related concerns via privacy-by-design (data minimization, transparent data-use, anonymous pickup); and (3) leverage HIV testing infrastructure. Moderately developed regions warrant priority attention given systematically lower willingness to disclose.