Post-test comparison of HIV test knowledge and changes in sexual risk behaviour between clients accessing HIV testing online versus in-clinic

Regulatory Focus and Sexual Health: Motives for Security and Pleasure in Sexuality are Associated with Distinct Protective Behaviors

We examined if motives for security (i.e., prevention focus) or pleasure (i.e., promotion focus) were uniquely associated with intentions to get tested for STIs and behavioral control over condom use, over and above variables already identified in theoretical models. We conducted an online survey with Portuguese adults (N = 836; M_age = 22.27, SD = 5.14). Overall, 99.4% of the participants knew at least one of eight STIs, but only 25.2% got tested in the last six months. Participants more focused on prevention had condomless sex less frequently, whereas participants more focused on promotion knew more STIs and got tested for more STIs. Furthermore, participants had stronger intentions to get tested for STIs if they got tested for more STIs in the past, were more concerned about STIs, perceived greater susceptibility to STI acquisition, and were more focused on promotion (but not prevention). Participants had greater behavioral control over condom use if they had condomless sex less often and were more focused on prevention (but not promotion). These findings suggest that promotion-focused people are more likely to consider the consequences of having condomless sex. In contrast, prevention-focused people are more likely to take control of their sexual health.

Sexual behaviour change following HIV testing services: a systematic review and meta-analysis

INTRODUCTION

Learning one's HIV status through HIV testing services (HTS) is an essential step toward accessing treatment and linking to preventive services for those at high HIV risk. HTS may impact subsequent sexual behaviour, but the degree to which this varies by population or is true in the setting of contemporary HIV prevention activities is largely unknown. As part of the 2019 World Health Organization Consolidated Guidelines on HTS, we undertook a systematic review and meta-analysis to determine the effect of HTS on sexual behaviour.

METHODS

We searched nine electronic databases for studies published between July 2010 and December 2019. We included studies that reported on at least one outcome (condom use [defined as the frequency of condom use or condom-protected sex], number of sex partners, HIV incidence, STI incidence/prevalence). We included studies that prospectively assessed outcomes and that fit into one of three categories: (1) those evaluating more versus less-intensive HTS, (2) those of populations receiving HTS versus not and (3) those evaluating outcomes after versus before HTS. We conducted meta-analyses using random-effects models.

RESULTS AND DISCUSSION

Of 29 980 studies screened, 76 studies were included. Thirty-eight studies were randomized controlled trials, 36 were cohort studies, one was quasi-experimental and one was a serial cross-sectional study. There was no significant difference in condom use among individuals receiving more-intensive HTS compared to less-intensive HTS (relative risk [RR]=1.03; 95% CI: 0.99 to 1.07). Condom use was significantly higher after receiving HTS compared to before HTS for individuals newly diagnosed with HIV (RR = 1.65; 95% CI: 1.36 to 1.99) and marginally significantly higher for individuals receiving an HIV-negative diagnosis (RR = 1.63; 95% CI: 1.01 to 2.62). Individuals receiving more-intensive HTS reported fewer sex partners at follow-up than those receiving less-intensive HTS, but the finding was not statistically significant (mean difference = -0.28; 95% CI: -3.66, 3.10).

CONCLUSIONS

Our findings highlight the importance of using limited resources towards HTS strategies that focus on early HIV diagnosis, treatment and prevention services rather than resources dedicated to supplementing or enhancing HTS with additional counselling or other interventions.

Does Women's Autonomy Matter on Attitude Towards Condom Use in Reducing Risk for HIV Infection Among Married Women in Ethiopia?

Background

Condom utilization remains as the forefront guard to reduce the HIV/AIDS pandemic. However, evidence showed that the dynamics of gendered power, beliefs, and attitudes about condoms and sexuality retards condom use for a large proportion of Africa's people. Therefore, this study aimed to assess the association between women's autonomy in health decision making and attitude to condom use in reducing risk for HIV in Ethiopia using a nationally representative, population-based household survey data.

Methods

A cross-sectional study was carried out using 2016 nationally representative, population-based Ethiopia Demographic and Health Survey. SPSS version 21 was used to analyze the data. Multivariate logistic regression analysis was performed to assess the association between women's autonomy in health decision making and attitude to condom use by controlling confounders. To declare statistically significant associations, adjusted odds ratios (AOR) with 95% confidence interval (CI) were used.

Results

The present study enrolled 6787 weighted samples of married women. The study showed that the odds of attitude toward condom use were 1.39 times (AOR: 1.39; 95% CI: 1.04-1.85) higher among women who decide for their health care compared to its counterparts. Also, the odds of attitude toward condom use were positively associated among women who conquered higher education (AOR: 1.97; 95% CI: 1.17-3.33), who had the richest wealth index quintile (AOR: 1.45; 95% CI: 1.01-2.07), and who had ever been tested for HIV (AOR: 1.31; 95% CI: 1.09-1.57). However, the odds of attitudes toward condom use were negatively associated among Muslims (AOR: 0.58; 95% CI: 0.46-0.74) and Protestant religion (AOR: 0.69; 95% CI: 0.54-0.88) followers.

Conclusion

The study culminates that women's autonomy in health decision making improves attitudes toward condom use during sex for HIV prevention in Ethiopia. Besides, women's higher education gets better wealth index, and HIV testing perks up the attitudes toward condom use; but religious affiliation deters it. Therefore, efforts need to be done in promoting women's autonomy along with empowering women in education, economic as well as HIV detection. Furthermore, designing interventions that address primary prevention strategies like using condoms consistently along with addressing religious affiliation can have a significant effect on curtailing HIV/AIDS scourge.

A cohort study comparing rate of repeat testing for sexually transmitted and blood-borne infections between clients of an internet-based testing programme and of sexually transmitted infection clinics in Vancouver, Canada

OBJECTIVES

Internet-based sexually transmitted and blood-borne infection (STBBI) testing services reduce testing barriers through bypassing face-to-face clinical encounters, potentially enabling clients at ongoing sexual risk to test more frequently. To our knowledge, this hypothesis has not been previously tested. We compared the frequency of repeat testing between Vancouver-based clients of GetCheckedOnline (GCO)-an internet-based STBBI testing service in British Columbia, Canada-and clients of three sexually transmitted infection (STI) clinics in Vancouver for 29 months after GCO launched.

METHODS

An administrative data cohort (n=19 497) was assembled using GCO, clinical and laboratory databases. We included all individuals who tested for HIV, gonorrhoea/chlamydia, syphilis or hepatitis C at three STI clinics or using GCO, between September 2014 and February 2017. The rate of repeat testing (>30 days after first episode) was compared between clients who used GCO at least once and those who tested only in STI clinics. Poisson regression was used to generate relative rate (RR) for repeat testing, with adjustment for age, gender/sexual orientation, risk factors (eg, history of STI diagnosis) and rate of testing before GCO launched.

RESULTS

1093 GCO clients were identified, of whom 434 (40%) had repeat test episodes; 8200/18 404 (45%) of clinic clients tested more than once. During the 29-month analysis period, GCO clients repeat tested 1.87 times per person-year, whereas clinic clients repeat tested 1.53 times per person-year, resulting in a crude RR of 1.22 (95% CI: 1.14 to 1.31). Adjustment for covariates increased the RR to 1.26 (95% CI: 1.15 to 1.37).

CONCLUSIONS

In this cohort, individuals using internet-based STBBI testing had a rate of repeat testing 22% greater than clinic-based clients. This effect was increased after adjusting for characteristics associated with higher test frequency. The online interface of GCO may facilitate more frequent testing and may therefore contribute to earlier STBBI diagnosis.