{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T20:11:30Z","timestamp":1771013490936,"version":"3.50.1"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"publisher","award":["NIH NIAID R01AI158826"],"award-info":[{"award-number":["NIH NIAID R01AI158826"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Aim<\/jats:title>\n Many STI testing services are underfunded. Pay-it-forward is a strategy to support STI testing that asks participants to donate money to spur others to receive STI testing. To explore factors influencing monetary donations, we performed a secondary analysis of data from a randomized controlled trial that evaluated a pay-it-forward strategy to increase STI testing among men in China.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We used a convergent parallel mixed-methods design to analyze data from the RCT and semi-structured interviews. Correlates of monetary donations were identified using logistic regression. Interview responses were analyzed using thematic analysis using charitable triad theory to explore donor, recipient, and organizational factors influencing donation behavior.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 800 men received the pay-it-forward intervention. Overall, 139\/718 (19%) made monetary donations, with a mean amount of 3.88 USD. The total value of all donations was 539.4 USD. At the donor level, donation behavior was associated with individual characteristics such as age, gender, and prior testing history. Donors who could identify with or visualize future recipients were also more likely to donate money. At the recipient level, income was not significantly associated with donation. At the organizational level, transparency and clear messaging enhanced trust and facilitated donations. An increased perceived risk of STI infection also motivated donations.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Our findings highlight key factors driving donations in a pay-it-forward program. Transparent fund allocation and real-time donor feedback can enhance trust and participation.<\/jats:p>\n <\/jats:sec>\n \n Clinical trial registration<\/jats:title>\n \n ClinicalTrials.gov\n NCT05723263<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0342595","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T18:33:28Z","timestamp":1771007608000},"page":"e0342595","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Financing STI testing among men in China: A mixed-methods study of pay-it-forward monetary donations"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4158-6646","authenticated-orcid":true,"given":"Ye","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ke","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lan","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7227-4130","authenticated-orcid":true,"given":"Gayed","family":"Salma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Fitzpatrick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gifty","family":"Marley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zixuan","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weiming","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2804-1181","authenticated-orcid":true,"given":"Joseph D.","family":"Tucker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"pone.0342595.ref001","unstructured":"WHO Global progress report on HIV, viral hepatitis and sexually transmitted infections 2021."},{"issue":"8","key":"pone.0342595.ref002","doi-asserted-by":"crossref","DOI":"10.1016\/S1473-3099(17)30310-9","article-title":"Sexually transmitted infections: challenges ahead","volume":"17","author":"M Unemo","year":"2017","journal-title":"Lancet Infect Dis"},{"issue":"7","key":"pone.0342595.ref003","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-016864","article-title":"The magnitude of, and factors associated with, loss to follow-up among patients treated for sexually transmitted infections: a multilevel analysis","volume":"7","author":"M Tsadik","year":"2017","journal-title":"BMJ Open"},{"issue":"5","key":"pone.0342595.ref004","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1007\/s10461-013-0588-8","article-title":"Incentivizing HIV\/STI testing: a systematic review of the literature","volume":"18","author":"R Lee","year":"2014","journal-title":"AIDS Behav"},{"issue":"7","key":"pone.0342595.ref005","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(21)00175-3","article-title":"Partner-delivered HIV self-test kits with and without financial incentives in antenatal care and index patients with HIV in Malawi: a three-arm, cluster-randomised controlled trial","volume":"9","author":"AT Choko","year":"2021","journal-title":"Lancet Glob Health"},{"issue":"9766","key":"pone.0342595.ref006","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1016\/S0140-6736(10)61884-3","article-title":"Financing health care for all: challenges and opportunities","volume":"377","author":"AKS Kumar","year":"2011","journal-title":"Lancet"},{"issue":"8","key":"pone.0342595.ref007","first-page":"445","article-title":"Healthcare Spending: Plenty of Blame to Go Around","volume":"9","author":"G Branning","year":"2016","journal-title":"Am Health Drug Benefits"},{"issue":"12","key":"pone.0342595.ref008","article-title":"Network homophily and the evolution of the pay-it-forward reciprocity","volume":"6","author":"Y-S Chiang","year":"2011","journal-title":"PLoS One"},{"key":"pone.0342595.ref009","unstructured":"Hyde CR. Pay it forward: Simon and Schuster; 2014."},{"issue":"12","key":"pone.0342595.ref010","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.46789","article-title":"Prosocial Interventions and Health Outcomes: A Systematic Review and Meta-Analysis","volume":"6","author":"M Byrne","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"1","key":"pone.0342595.ref011","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S1473-3099(18)30556-5","article-title":"Pay-it-forward strategy to enhance uptake of dual gonorrhea and chlamydia testing among men who have sex with men in China: a pragmatic, quasi-experimental study","volume":"19","author":"KT Li","year":"2019","journal-title":"Lancet Infect Dis"},{"issue":"9","key":"pone.0342595.ref012","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1097\/OLQ.0000000000001659","article-title":"Development of a Psychometric Tool to Measure Community Solidarity Among Sexual Minorities: Evidence From a Pay-it-Forward 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and fundraisers influence charitable giving","volume":"39","author":"CM Chapman","year":"2022","journal-title":"Psychology and Marketing"},{"issue":"7","key":"pone.0342595.ref021","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(21)00175-3","article-title":"Partner-delivered HIV self-test kits with and without financial incentives in antenatal care and index patients with HIV in Malawi: a three-arm, cluster-randomised controlled trial","volume":"9","author":"AT Choko","year":"2021","journal-title":"Lancet Glob Health"},{"issue":"6","key":"pone.0342595.ref022","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1521\/aeap.2022.34.6.512","article-title":"Utilization of HIV Prevention, Care, and Treatment Services Among Young Men Who Have Sex With Men and Transgender Persons of Color in the U.S. South: A Qualitative Analysis","volume":"34","author":"Y Mizuno","year":"2022","journal-title":"AIDS Educ Prev"},{"issue":"20","key":"pone.0342595.ref023","doi-asserted-by":"crossref","first-page":"9790","DOI":"10.1073\/pnas.1807942116","article-title":"No evidence that economic inequality moderates the effect of income on generosity","volume":"116","author":"SC Schmukle","year":"2019","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"52","key":"pone.0342595.ref024","doi-asserted-by":"crossref","first-page":"15838","DOI":"10.1073\/pnas.1511536112","article-title":"High economic inequality leads higher-income individuals to be less generous","volume":"112","author":"S C\u00f4t\u00e9","year":"2015","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"6","key":"pone.0342595.ref025","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1027\/1864-9335\/a000466","article-title":"The link between income, income inequality, and prosocial behavior around the world: A multiverse approach","volume":"52","author":"L Macchia","year":"2023","journal-title":"Social Psychology"},{"key":"pone.0342595.ref026","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5171\/2022.506046","article-title":"Agency Relation in Online Charity Crowdfunding: The Role of Transparency to Attract Donation","author":"IN Hariwibowo","year":"2022","journal-title":"IBIMABR"},{"key":"pone.0342595.ref027","volume-title":"Andreoni JPIL-AG-V S-CKJMYE. Handbook of giving, reciprocity and altruism North-Holland","year":"2006"},{"key":"pone.0342595.ref028","doi-asserted-by":"crossref","unstructured":"Heiss SCaA. 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