LETTERS TO THE EDITOR Reply To the Editors: Many thanks to Dr. Clement et al for their interest in our brief report, which highlighted the disparate uptake of HIV preexposure prophylaxis (PrEP) by popu- lations that are most affected by the HIV epidemic, in particular black men who have sex with men (MSM) in the United States Deep South. In our brief report, it was emphasized that community-based support systems, as well as, targeted messaging, and novel strategies may be necessary to increase uptake of HIV preexposure pro- phylaxis (PrEP) in this high-risk popula- tion. As evident by our primary referral source, most patients in our cohort were referred by a sexual partner (34%) or health care provider (21%), and not by a commu- nity-based organization (8%). This likely contributed to our initial HIV preexposure prophylaxis (PrEP) cohort demographics, with under-representation of black MSM. The authors of this letter provide proof of concept that partnerships with community-based organizations can be extremely successful as a referral source for black patients, whereas relying on self- referrals and/or PCP referrals may not result in patient demographics reflective of the current epidemic. We are similarly relying on strong partnerships with com- munity agencies and local health depart- ments to leverage existing relationships within the community to increase uptake of PrEP among black MSM in our South- ern state. Moreover, we are actively work- ing with clinical, community, and public health partners across the state to provide awareness, education, and technical assis- tance in developing and implementing PrEP service delivery programs in tradi- tional clinical settings, as well as alternative community-based venues. Qualitative stud- ies we have conducted with black MSM have suggested that novel, nontraditional venues for PrEP delivery may be preferable and enhance the uptake of this biomedical prevention tool (Elopre, unpublished data, 2017). We feel that there is an urgent need for more public health and implementation science research to identify best practices for targeted outreach to increase uptake of PrEP among those in greatest need to prevent further ampli fication of HIV health disparities, which are particularly magni- fied in the Deep South among black MSM. Latesha Elopre, MD Kachina Kudroff, MPH Andrew O. Westfall, MS Edgar T. Overton, MD Michael J. Mugavero, MD Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL Coercion and HIV Self-Testing in Men Who Have Sex With Men: Implementation Data From a Cross-Sectional Survey in China To the Editors: INTRODUCTION HIV self-testing (HIVST) scale up may help achieve the first 90 within the UNAIDS 90-90-90 targets. 1 HIVST is defined as a process in which a person collects his/her own specimen (oral fluid or blood) and then performs a test and interprets the result, often in a private setting, either alone or with someone he or she trusts. 2 New World Health Orga- nization (WHO) guidelines supporting HIVST have provided momentum for self-testing. 2 Although HIVST increases agency about when, where, and with whom to test, 3,4 one unintended conse- quence may be an increase in coercive HIV testing. We define coercion as being forced to test. This may be through physical means (with actual violence or threat of violence) or could involve threats to take away something if the person does not do the test (eg, losing their job, breaking up a relation- ship, and not having sex). The WHO and others state that HIV testing must be voluntary. 2,5 However, cases of coerced testing have been observed among women forced by their employers (both in sex work and nonsex work set- tings), 3,6 detained individuals (prisoners, drug users, and sex workers) forced by institutions, 7,8 and young people forced by their sex partners. 3 In China, there is an emphasis on public health responses focused on expanding key population HIV testing and a history of compulsory HIV testing among several subpopula- tions. 9 For example, in 1995, a Chinese law required premarital HIV testing, 10 and sex workers and drug users often receive compulsory testing in detention settings. 7,9,11 In recent years, China has rapidly scaled up HIVST, partly driven by a thriving online self-test kit market. 12 Surveys of men who have sex with men (MSM) report that approximately a third have already used HIVST. 13 In a setting where HIV testing has become more decentralized, it is unknown if coercion may be occurring. We aimed to examine the prevalence and correlates of coerced HIV testing among MSM in China. METHODS From July to August 2016, an online, cross-sectional study among L.E. is currently receiving Grant 1K23MH112417- 01 from the National Institute of Mental Health. The remaining authors have no funding or conflicts of interest to disclose. Supported by the National Institutes of Health (NIAID 1R01AI114310-01), UNC-South China STD Research Training Center (FIC 1D43TW009532- 01), UNC Center for AIDS Research (NIAID 5P30AI050410), UCSF Center for AIDS Research (NIAID P30 AI027763), National Insti- tute of Mental Health (R00MH093201), UJMT Fogarty Fellowship (FIC R25TW0093), Austra- lian National Health and Medical Research Council (APP1104781), and SESH Global (www.seshglobal.org). Administrative assistance from the Guangdong Provincial Center for Skin Diseases and STI Control. UNC Chapel Hill and UNC Project-China in Guangzhou, China. The authors have no conflicts of interest to disclose. J.D.T., H.L., and C.L. contributed to the conception and design of the study. C.W. and B.Y. provided oversight for data collection, and W.M., D.K., M. L., G.M., L.Y., and S.H. assisted in the data collection. E.L. assisted with the literature search. J.J.O. analyzed the data and drafted the paper. All authors revised the manuscript and approved the final version to be published. J.J.O. and H.L. are first authors equally. e22 | www.jaids.com J Acquir Immune Defic Syndr  Volume 77, Number 2, February 1, 2018 Copyright Ó 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.