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Background  Peer education and HIV risk perception are related to HIV testing uptake among key populations. We aimed to examine the association between peer education, HIV risk perception, and HIV testing uptake, as well as to evaluate the mediated effect of HIV risk perception in the relationship between peer education and HIV testing uptake.    Methods  We conducted a cross-sectional survey among 1188 HIV-uninfected or unknown participants from populations of men who have sex with men (MSM), female sex workers (FSWs), and drug users (DUs) in seven cities of China. Partial correlation analysis and regression analysis were employed to examine the associations among peer education, HIV risk perception, and HIV testing uptake. Mediation analysis was conducted to assess whether HIV risk perception mediated the hypothesized association.    Results  Receiving peer education was associated with higher odds of HIV testing uptake among MSM, FSWs and DUs. Perceiving risk of HIV infection was associated with higher odds of HIV testing uptake among MSM and DUs. Among MSM, the relationship between peer education and HIV testing uptake was mediated by moderate risk perception of HIV (indirect effect: 0.53, 95% CI 0.07 to 1.21), and by high risk perception of HIV (indirect effect: 0.50, 95% CI 0.01 to 1.17). Among DUs, the relationship between peer education and HIV testing uptake was mediated by moderate risk perception of HIV (indirect effect: 1.80, 95% CI 0.57 to 3.45).    Conclusions  Participants who received peer education tended to perceive their risk of HIV infection, which in turn was associated with increased HIV testing uptake among MSM and DUs. Therefore, in addition to peer education interventions, more report about HIV epidemic and risk assessment should also be scaled up to enhance HIV risk perception among key populations.

The mediated effect of HIV risk perception in the relationship between peer education and HIV testing uptake among three key populations in China