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Toledo LDSG, Palmieri P, Ribeiro GDR, Silva AD, Bastos FI. Barriers and facilitators for HIV rapid testing among transgender women and gay and other men who have sex with men in Brazil: A scoping review. Glob Public Health 2024; 19:2360982. [PMID: 38937916 DOI: 10.1080/17441692.2024.2360982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/21/2024] [Indexed: 06/29/2024]
Abstract
Transgender women (TGW) and men who have sex with other men (MSM) often encounter disparities in accessing HIV testing, leading to delayed diagnoses and worse prognoses. We analysed barriers and facilitators for accessing HIV rapid testing by TGW and MSM in Brazil, 2004-2023. Citations were included whether the study population consisted of individuals aged ≥18y old, and studies addressed HIV testing and have been conducted in Brazil. The study protocol was based on Joanna Briggs' recommendations for scoping reviews. We included 11 studies on TGW and 17 on MSM. The belief that one is not at risk of contracting HIV infection, fear expressed in different ways (e.g. lack of confidentiality) and younger age were the main barriers. Feeling at risk for HIV infection, curiosity, and favourable characteristics of the setting where the testing takes place were cited as the main facilitators. Barriers and facilitators specifically for HIV self-testing included, respectively, concerns about conducting the test alone vs. autonomy/flexibility. Brazil is unlikely to achieve the UN' 95-95-95 goal without minimising testing disparities. Combating prejudice against TGW and MSM in testing settings, along with educational campaigns and transparent protocols to ensure confidentiality, can help increase HIV testing among these populations.
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Affiliation(s)
| | - Paloma Palmieri
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Gizele da Rocha Ribeiro
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Adriano da Silva
- National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Francisco Inácio Bastos
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Khezri M, Goldmann E, Tavakoli F, Karamouzian M, Shokoohi M, Mehmandoost S, Ghalekhani N, Haghdoost AA, Des Jarlais D, Mirzazadeh A, Sharifi H. Awareness and willingness to use HIV self-testing among people who inject drugs in Iran. Harm Reduct J 2023; 20:145. [PMID: 37805505 PMCID: PMC10560425 DOI: 10.1186/s12954-023-00881-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/03/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Most people who inject drugs (PWID) in Iran have not undergone recent HIV testing. While PWID face barriers when seeking HIV testing at health facilities, HIV self-testing (HIVST) could be a promising approach to improve HIV testing uptake. We examined the awareness and willingness to use HIVST among PWID in Iran. We also identified participants' characteristics associated with a higher willingness to use HIVST. METHODS PWID were recruited in 11 cities using a respondent-driven sampling method. Willingness to use HIVST was defined as a binary variable (very low/low willingness vs. high/very high willingness). We performed multivariable modified Poisson regression to examine associated factors and report adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). RESULTS Of 2,252 PWID, 362 (16.2%; 95% CI 14.7, 17.8) had ever heard of HIVST; however, 1,658 (73.6%; 95% CI 71.7, 75.4) reported high/very high willingness to use HIVST. Willingness to use HIVST was higher among PWID who reported having a high/moderate HIV risk perception (aPR 1.22; 95% CI 1.09, 1.37), ever experiencing homelessness (aPR 1.15; 95% CI 1.03, 1.28), > 10 years of injecting history (aPR 1.16; 95% CI 1.00, 1.34), and high injection frequency in the last three months (aPR 1.18; 95% CI 1.05, 1.32). CONCLUSION Most PWID in Iran, particularly those experiencing homelessness, have a longer injecting history, engage in more frequent injection practices, and possess a heightened perception of HIV risk would be willing to adopt HIVST. Enhancing HIVST awareness through increased access to HIVST and health education programs are needed. Additionally, conducting implementation science studies to effectively design and run HIVST programs in Iran can also increase PWID's access to HIV testing.
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Affiliation(s)
- Mehrdad Khezri
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Emily Goldmann
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Fatemeh Tavakoli
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Sciences, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Soheil Mehmandoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nima Ghalekhani
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Don Des Jarlais
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Jiang H, He W, Pan H, Zhong X. A structural equation modeling approach to investigate HIV testing willingness for men who have sex with men in China. AIDS Res Ther 2023; 20:64. [PMID: 37661282 PMCID: PMC10476389 DOI: 10.1186/s12981-023-00561-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND A substantial risk of contracting Human immunodeficiency virus (HIV) exists among men who have sex with men (MSM), and HIV infection rates have been rising. This study aimed to analyze the factors influencing the Chinese MSM population's intention to test for HIV. METHODS Nonprobability sampling techniques were employed in June 2022 to recruit MSM in Chongqing and Sichuan, China. The data were analyzed using structural equation modeling (SEM), which is based on the knowledge-attitude-behavior (KAB) theory. RESULTS Among 1687 participants, 964 (57.1%) of the MSM were willing to have an HIV test. The results of the structural equation modeling (SEM) showed that knowledge, attitude, and behavior all influenced the testing intention, with attitude having the greatest impact (total effect of 0.22). CONCLUSION HIV testing needs to be increased among MSM as they exhibit a moderate willingness to test. Improving education on HIV knowledge and risk behavior might enhance the willingness of MSM to test for HIV in China.
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Affiliation(s)
- Han Jiang
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Wei He
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Haiying Pan
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Xiaoni Zhong
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China.
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Kandil C, Hugtenburg J, Heijman T, Bos H, Teichert M, Finkenflügel R, de Coul EO. Availability and accessibility of HIV self-tests and self-sample kits at community pharmacies in the Netherlands. AIDS Res Ther 2023; 20:39. [PMID: 37349835 PMCID: PMC10288660 DOI: 10.1186/s12981-023-00529-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND In 2016 the WHO declared HIV self-testing and self-sampling an effective and safe test option that can reduce testing barriers. HIV self-tests and self-sampling kits (HIVST/HIVSS) are available for purchase at Dutch community pharmacies since 2019. We investigated the availability and accessibility of HIVST/HIVSS in community pharmacies, and factors associated with test availability. METHODS An online survey among all Dutch community pharmacies (n = 1,987) was conducted between April and June 2021. Availability of HIVST/HIVSS and experiences of pharmacists with the test offer were analyzed with descriptive statistics. The association of pharmacy and pharmacists' characteristics with HIVST/HIVSS availability was explored by logistic regression analysis. RESULTS In total, 465 pharmacists completed the questionnaire. Of the responding pharmacists, 6.2% (n = 29) offered HIVST/HIVSS. The majority (82.8%) sold between 0 and 20 tests per year. In total, pharmacies sold an estimated 370 HIVST/HIVSS per year. Pharmacies having HIVST/HIVSS available were less often located in moderately-urbanized to rural neighborhoods (OR 0.35, 95%CI 0.16-0.77 versus highly-urbanized), and were less often located in moderate-to-low SES neighborhoods (OR 0.40, 95%CI 0.18-0.88 versus high-SES). Reasons for not offering HIVST/HIVSS by pharmacists were no or little demand (69.3%), and not being familiar with these tests (17.4%). 52% of the pharmacists provided information about testing to test buyers. Reported options to improve the test offer were giving advice about (performing) the test to test buyers (72.4%), placing tests visible on the counter (51.7%), and advertisement (37.9%). CONCLUSION HIVST/HIVSS have a limited practical availability in Dutch community pharmacies since their introduction in 2019, especially in lower-urbanized and lower-SES areas. Further research is needed to explore how to expand access to HIVST/HIVSS through community pharmacies in the Netherlands, and how to tailor it to the needs of pharmacy clients.
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Affiliation(s)
- Chaima Kandil
- National Institute for Public Health and the Environment, Center for Infectious Disease Control, P.O. Box 1, Bilthoven, 3720 BA, the Netherlands
| | | | - Titia Heijman
- Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Hanna Bos
- STI Aids Netherlands, Amsterdam, the Netherlands
| | - Martina Teichert
- Royal Dutch Pharmacists Association (KNMP), the Hague, the Netherlands
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Renee Finkenflügel
- Dutch Association of People with HIV (the HIV vereniging), Amsterdam, the Netherlands
| | - Eline Op de Coul
- National Institute for Public Health and the Environment, Center for Infectious Disease Control, P.O. Box 1, Bilthoven, 3720 BA, the Netherlands.
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Gosset D, Plathey M, Lert F, Lasry S, Jedrzejewski T, Gazalet P, L'Yavanc T, Pierre N, Kachal A, Frémondière M, Ohayon M, Palich R. Distribution of HIV self-tests by men who have sex with men attending a French sexual health centre: results of the OTO study. Sex Transm Infect 2023; 99:116-119. [PMID: 35459755 DOI: 10.1136/sextrans-2022-055417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/02/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES HIV self-tests (HSTs) have been deployed to reduce the burden of undiagnosed HIV infections in subpopulations undertested. We assumed that patients attending sexual health centres could themselves distribute HSTs in their close network. This study aimed to assess the proportion and the characteristics of the participants who distributed HSTs, as well as the characteristics of people who received HSTs. METHODS Three HSTs were given to patients attending "Le 190" Sexual Health Center, Paris, France, having consented for the study, between July 2018 and August 2020. Participants had to distribute HSTs within 6 months, preferably to individuals in their close circle who have not been tested for a long time. Then they had to complete a self-questionnaire, exploring HIV status, sexual practices, number of distributed HSTs, profile of persons who received HSTs, and if known, result of used HSTs. Univariable logistic regression was used to determine factors associated with HST distribution. RESULTS Overall, 682/1062 (64%) patients accepted to be included in the study, and 283/682 (42%) completed the questionnaire. 97% were men who have sex with men (MSMs), including 86 (30%) HIV-positive individuals and 119 (42%) HIV Pre-Exposure Prophylaxis (PrEP) users. The proportion of participants having distributed 0, 1, 2 or 3 HSTs was 31%, 15%, 27% and 27%, respectively. Participants having distributed at least one HST (n=195, 69%) were more likely to have previously used HSTs themselves (OR=3.90, 95% CI=1.84 to 8.29, p<0.001). On the 901 HSTs in possession of participants who answered the questionnaire, 455 (50%) were distributed. 79% of recipients were MSMs, and 42% of whom had not been tested for more than 1 year. The result was known for 220 HSTs, including 5 positive (2.3%). CONCLUSION MSMs attending sexual health centres could be good disseminators of HSTs, targeting a population with high level of undiagnosed HIV infections, especially if they have already experimented it.
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Affiliation(s)
- Daniel Gosset
- Department of Infectious Disease, Hospital Tenon, Paris, France .,"Le 190" Sexual Health Center, Paris, France
| | | | | | - Stéphane Lasry
- Department of Infectious Disease, Hospital Tenon, Paris, France.,"Le 190" Sexual Health Center, Paris, France
| | | | | | - Thomas L'Yavanc
- "Le 190" Sexual Health Center, Paris, France.,Hôpital Jean Jaurès, Paris, France
| | | | | | | | - Michel Ohayon
- Department of Infectious Disease, Hospital Tenon, Paris, France.,"Le 190" Sexual Health Center, Paris, France
| | - Romain Palich
- "Le 190" Sexual Health Center, Paris, France.,Sorbonne University, Paris, France
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HIV Testing Strategies, Types of Tests, and Uptake by Men Who have Sex with Men and Transgender Women: A Systematic Review and Meta-analysis. AIDS Behav 2023; 27:678-707. [PMID: 35984608 DOI: 10.1007/s10461-022-03803-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/01/2022]
Abstract
This systematic review and meta-analysis investigated the effectiveness of strategies and types of tests on HIV testing uptake by men who have sex with men (MSM) and transgender women (TGW), and in reaching PLWH. Articles published up to July 2020 were identified from major electronic databases and grey literature. Data were extracted and assessed for risk of bias. Estimates were pooled using random-effect meta-analysis while heterogeneity was evaluated by Cochran's Q test and I2. This study is registered with PROSPERO (CRD42020192740). Of 6820 titles, 263 studies (n = 67,288 participants) were included. The testing strategies reported in most studies were community- (71.2%) and facility-based (28.8%). Highest uptake, with facility-based testing, occurred and reached more PLWH while with standard laboratory tests, it occurred with the highest HIV prevalence among MSM. However, urine test showed a highest rate of new HIV infection. Multiple test combinations had the highest uptake and reached more PLWH among TGW. Various testing strategies, considering barriers and regional differences, and different test types, need be considered, to increase uptake among MSM and TGW.
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7
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Sison OT, Baja ES, Bermudez ANC, Quilantang MIN, Dalmacion GV, Guevara EG, Garces-Bacsal RM, Hemingway C, Taegtmeyer M, Operario D, Biello KB. Association of anticipated HIV testing stigma and provider mistrust on preference for HIV self-testing among cisgender men who have sex with men in the Philippines. BMC Public Health 2022; 22:2362. [PMID: 36527003 PMCID: PMC9756449 DOI: 10.1186/s12889-022-14834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND New HIV infections in the Philippines are increasing at an alarming rate. However, over three quarters of men who have sex with men (MSM) have never been tested for HIV. HIV self-testing (HIVST) may increase overall testing rates by removing barriers, particularly fear of stigmatization and mistrust of providers. This study aimed to determine if these factors are associated with preference for HIVST among Filipino cisgender MSM (cis-MSM), and whether there is an interaction between anticipated HIV testing stigma and provider mistrust on preference for HIVST. METHODS We conducted secondary analysis of a one-time survey of 803 cis-MSM who were recruited using purposive sampling from online MSM dating sites and MSM-themed bar locations in Metro Manila, Philippines. Summary statistics were computed to describe participant characteristics. Multivariable modified Poisson regression analyses were conducted to determine if anticipated HIV testing stigma and provider mistrust were associated with preference for HIVST among cis-MSM. Other variables such as age, education, monthly income, relationship status, HIV serostatus, and knowing where to get HIV testing were the minimal sufficient adjustment set in the analyses. RESULTS Average age of participants was 28.6 years (SD = 8.0); most had received college degrees (73%) and were employed (80%). Most respondents (81%) preferred facility-based testing, while 19% preferred HIVST. A high percentage of participants reported anticipated HIV testing stigma (66%) and provider mistrust (44%). Anticipated HIV testing stigma (aPR = 1.51; 95% CI = 1.01-2.25, p = 0.046) and provider mistrust (aPR = 1.49; 95% CI = 1.07-2.09, p = 0.020) were independently associated with a preference for HIVST. There was a positive, additive interaction between provider mistrust and anticipated HIV testing stigma on preference for HIVST (RERI = 1.13, 95% CI: 0.20-2.06; p = 0.017), indicating that the association between anticipated HIV testing stigma and preference for HIVST is greater among those with provider mistrust compared to those without provider mistrust. CONCLUSIONS HIVST should be offered as a supplement to traditional facility-based HIV testing services in the Philippines to expand testing and reach individuals who may not undergo testing due to anticipated HIV testing stigma and provider mistrust.
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Affiliation(s)
- Olivia T. Sison
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, RI USA
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Metro Manila, Philippines
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Emmanuel S. Baja
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Metro Manila, Philippines
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Amiel Nazer C. Bermudez
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, RI USA
- Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Ma. Irene N. Quilantang
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, RI USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA
- Department of Behavioral Sciences, College of Arts and Sciences, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Godofreda V. Dalmacion
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Ernest Genesis Guevara
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Rhoda Myra Garces-Bacsal
- Department of Special Education, College of Education, United Arab Emirates University, P.O. Box 15551, Al Ain, UAE
| | - Charlotte Hemingway
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Palace Liverpool, Liverpool, L3 5QA UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Palace Liverpool, Liverpool, L3 5QA UK
- Tropical Infectious Disease Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP UK
| | - Don Operario
- The Philippine Health Initiative for Research, Service, and Training, Brown University Global Health Initiative, Providence, RI USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Katie B. Biello
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA
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Lee DYL, Ong JJ, Smith K, Jamil MS, McIver R, Wigan R, Maddaford K, McNulty A, Kaldor JM, Fairley CK, Bavinton B, Chen M, Chow EPF, Grulich AE, Holt M, Conway DP, Stoove M, Wand H, Guy RJ. The acceptability and usability of two
HIV
self‐test kits among men who have sex with men: a randomised crossover trial. Med J Aust 2022; 217:149-154. [PMID: 35820664 PMCID: PMC9542976 DOI: 10.5694/mja2.51641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/13/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022]
Abstract
Objectives Design Setting, participants Main outcome measures Results Conclusion
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Affiliation(s)
- Dana YL Lee
- Central Clinical School Monash University Melbourne VIC
| | - Jason J Ong
- Central Clinical School Monash University Melbourne VIC
- Melbourne Sexual Health Centre Alfred Health Melbourne VIC
| | - Kirsty Smith
- Kirby Institute University of New South Wales Sydney NSW
| | - Muhammad S Jamil
- Global HIV, Hepatitis and STI Programmes, World Health Organization Geneva Switzerland
| | | | - Rebecca Wigan
- Melbourne Sexual Health Centre Alfred Health Melbourne VIC
| | - Kate Maddaford
- Melbourne Sexual Health Centre Alfred Health Melbourne VIC
| | - Anna McNulty
- Sydney Sexual Health Centre Sydney NSW
- The University of New South Wales Sydney NSW
| | - John M Kaldor
- Kirby Institute University of New South Wales Sydney NSW
| | - Christopher K Fairley
- Melbourne Sexual Health Centre Alfred Health Melbourne VIC
- Kirby Institute University of New South Wales Sydney NSW
| | | | - Marcus Chen
- Central Clinical School Monash University Melbourne VIC
- Melbourne Sexual Health Centre Alfred Health Melbourne VIC
| | - Eric PF Chow
- Central Clinical School Monash University Melbourne VIC
- Melbourne Sexual Health Centre Alfred Health Melbourne VIC
| | | | - Martin Holt
- Kirby Institute University of New South Wales Sydney NSW
| | | | | | - Handan Wand
- Kirby Institute University of New South Wales Sydney NSW
| | - Rebecca J Guy
- Kirby Institute University of New South Wales Sydney NSW
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Guerras JM, Belza MJ, Fuster MJ, de la Fuente L, García de Olalla P, Palma D, García-Pérez JN, Hoyos J. Knowledge and Prior Use of HIV Self-Testing in Madrid and Barcelona among Men Who Have Sex with Men More than One Year after Its Legal Authorization in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031096. [PMID: 35162118 PMCID: PMC8834423 DOI: 10.3390/ijerph19031096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 01/25/2023]
Abstract
This study assessed the knowledge and prior use of HIV self-testing in a sample of men who have sex with men (MSM) recruited in a sexual health clinic and two community-based testing sites in Madrid and Barcelona, >12 months after its legal authorization. Between March 2019 and December 2020, we recruited 2044 MSM. Participants completed a self-administered questionnaire while waiting to be tested for HIV and other STIs. We built two Poisson regression models to assess factors associated with prior knowledge and with use. Among those who had used self-testing in the past we assessed frequency of use and several aspects related to the last testing episode. The proportion of participants that knew about the existence of self-testing and had already used it was of 26.3% and 5.1% respectively. Both, knowledge and use were independently associated with being born in Spain or other western European countries, university education and more recent HIV testing. Additionally, knowledge was associated with older age, having a more favorable economic situation, and not living sexuality in total secrecy. Use was also associated with having received money in exchange for sex. Most (69.5%) reported having self-tested once, 64.8% had self-tested <12 months ago, 63.8% self-tested alone and 71.4% acquired the kit at a pharmacy over the counter. In spite of its authorization and becoming legally available, knowledge and use of HIV self-testing remain low among MSM attending sites specialized in the diagnosis of HIV and other STIs. When designing scale-up strategies, lower levels of knowledge and use in less favored subgroups of MSM need to be factored in.
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Affiliation(s)
- Juan-Miguel Guerras
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.-M.G.); (L.d.l.F.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
| | - María-José Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - María-José Fuster
- Sociedad Española Interdisciplinaria del SIDA, SEISIDA, 28036 Madrid, Spain;
- Departamento de Psicología Social y de las Organizaciones, Universidad Nacional de Educación a Distancia, 28040 Madrid, Spain
| | - Luis de la Fuente
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.-M.G.); (L.d.l.F.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
| | - Patricia García de Olalla
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | - David Palma
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.G.d.O.); (D.P.)
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | | | - Juan Hoyos
- Independent Researcher, 28013 Madrid, Spain;
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Ferguson L, Narasimhan M, Gutierrez J, Jardell W, Gruskin S. Law, human rights and gender in practice: an analysis of lessons from implementation of self-care interventions for sexual and reproductive health. Sex Reprod Health Matters 2022; 29:2105284. [PMID: 35975874 PMCID: PMC9387312 DOI: 10.1080/26410397.2022.2105284] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Self-care interventions for health are becoming increasingly available, and among the preferred options, including during the COVID-19 pandemic. This research assessed the extent of attention to laws and policies, human rights and gender in the implementation of self-care interventions for sexual and reproductive health (SRH), to identify where additional efforts to ensure an enabling environment for their use and uptake will be useful. A literature review of relevant studies published between 2010 and 2020 was conducted using PubMed, Scopus and Web of Science. Relevant data were systematically abstracted from 61 articles. In March–April 2021, semi-structured interviews were conducted with 10 key informants, selected for their experience implementing self-care interventions for SRH, and thematically analysed. Laws and policies, rights and gender are not being systematically addressed in the implementation of self-care interventions for SRH. Within countries, there is varied attention to the enabling environment including the acceptability of interventions, privacy, informed consent and gender concerns as they impact both access and use of specific self-care interventions, while other legal considerations appear to have been under-prioritised. Operational guidance is needed to develop and implement supportive laws and policies, as well as to ensure the incorporation of rights and gender concerns in implementing self-care interventions for SRH.
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Affiliation(s)
- Laura Ferguson
- Associate Professor of Population and Public Health Sciences, Director of Research, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA. Correspondence:
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, Geneva, Switzerland
| | - Jose Gutierrez
- Student, University of Southern California, Los Angeles, CA, USA
| | - William Jardell
- Project Specialist, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Sofia Gruskin
- Professor of Population and Public Health Sciences and Law, Director, USC Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
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Morell-Mengual V, Gil-Llario MD, Fernádez-García O, Ballester-Arnal R. Factors Associated with Condom Use in Anal Intercourse Among Spanish Men Who Have Sex with Men: Proposal for an Explanatory Model. AIDS Behav 2021; 25:3836-3845. [PMID: 33914210 DOI: 10.1007/s10461-021-03282-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/24/2022]
Abstract
Men who have sex with men (MSM) account for more than half of the new HIV diagnoses in Spain. This study aims to carry out a descriptive analysis of the sexual practices and frequency of condom use of MSM and identify the variables that explain inconsistent condom use during anal intercourse. The sample consists of 405 men between 18 and 60 years of age (M = 28.94; SD = 9.35). The results indicate that the percentage of consistent condom use is 72.9% for anal intercourse. Lack of risk perception, high self-esteem, and greater sensation-seeking are risk factors for risky sexual behavior. In contrast, high levels of sexual assertiveness and self-efficacy are protective factors. The proposed model explains between 33.8 and 49.2% of the variance. These findings highlight the importance of designing and implementing condom promotion programs for MSM who engage in anal intercourse with specific sections that consider the acquisition of assertive skills and reduce the risks associated with a perceived invulnerability to HIV.
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Affiliation(s)
- Vicente Morell-Mengual
- Department of Developmental and Educational Psychology, Universitat de València, Valencia, Spain
| | - M Dolores Gil-Llario
- Department of Developmental and Educational Psychology, Universitat de València, Valencia, Spain.
| | - Olga Fernádez-García
- Department of Developmental and Educational Psychology, Universitat de València, Valencia, Spain
| | - Rafael Ballester-Arnal
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
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12
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Vasconcelos R, Avelino-Silva VI, de Paula IA, Jamal LF, Gianna MC, Santos F, Camargo R, Barbosa E, Casimiro G, Cota V, Abbate MC, Cruz M, Segurado AC. HIV self-test: a tool to expand test uptake among men who have sex with men who have never been tested for HIV in São Paulo, Brazil. HIV Med 2021; 23:451-456. [PMID: 34634182 DOI: 10.1111/hiv.13178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES HIV self-testing is an effective tool to improve diagnostic coverage in key populations, enabling linkage to care and access to antiretroviral therapy. Its implementation requires better understanding of patients' perspectives on this novel strategy. The aim of the study was to investigate the perception of men who have sex with men (MSM) regarding the HIV oral fluid self-test (HIVST) in São Paulo, Brazil, and to analyse the sociodemographic characteristics and testing strategy preferences of individuals registered to undertake HIVST. METHODS Preceding the implementation of HIVST use as public policy in 2019, we recruited MSM living in São Paulo to undertake HIVST using a digital platform, and investigated their sociodemographic profiles, testing experiences and testing preferences. Results were compared according to reported lifetime HIV testing. RESULTS A total of 6477 MSM (median age 28 years) were recruited to the study from April 9th to December 31st, 2018. Seventy-eight per cent reported previous HIV testing. The opening hours of health facilities (53%), concern about disclosing intimate personal information to health care providers (34%) and fear of stigma (21%) were reported as the main barriers to testing. Older age, higher education, illicit drug use and self-identifying as gay were associated with prior HIV testing (P < 0.001). Most participants (67%) were unaware that HIVST was available before enrolling in the study. Preference for HIVST over other testing technologies was higher among those never tested (71%) than among participants with previous HIV testing (61%; P < 0.001). CONCLUSIONS HIVST was found to be an effective tool to improve testing uptake among MSM, particularly those who had never been tested before. Characterization of the most likely users of HIVST among MSM will help to inform implementation and scaling up of this novel testing method in the Brazilian public health system.
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Affiliation(s)
- Ricardo Vasconcelos
- Department/Division of Infectious Diseases, Faculty of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Vivian I Avelino-Silva
- Department/Division of Infectious Diseases, Faculty of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - Ivone A de Paula
- STD/AIDS Reference and Training Centre, State Secretariat of Health of São Paulo, São Paulo, Brazil
| | - Leda F Jamal
- STD/AIDS Reference and Training Centre, State Secretariat of Health of São Paulo, São Paulo, Brazil
| | - Maria Clara Gianna
- STD/AIDS Reference and Training Centre, State Secretariat of Health of São Paulo, São Paulo, Brazil
| | - Flavio Santos
- STI/AIDS Coordination of the city of São Paulo, Municipal Secretariat of Health, São Paulo, Brazil
| | - Robinson Camargo
- STI/AIDS Coordination of the city of São Paulo, Municipal Secretariat of Health, São Paulo, Brazil
| | | | - Gilvane Casimiro
- Department of Chronic Health Conditions and Sexually Transmitted Infections, Ministry of Health, Brasilia, Brazil
| | - Vanda Cota
- National School of Public Health, Fiocruz, Rio de Janeiro, Brazil
| | - Maria C Abbate
- STI/AIDS Coordination of the city of São Paulo, Municipal Secretariat of Health, São Paulo, Brazil
| | - Marly Cruz
- National School of Public Health, Fiocruz, Rio de Janeiro, Brazil
| | - Aluisio C Segurado
- Department/Division of Infectious Diseases, Faculty of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
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13
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Nash SG, Maffeo M, Likatavicius G, Cosmaro L, Rudaitis K, Lapsinov A, Enayat Q, Delpech V, Kall M. Acceptability and usability of HIV self-tests in two European countries: findings from surveys of clients at non-governmental organisations in Lithuania and Italy. BMC Infect Dis 2021; 21:844. [PMID: 34517818 PMCID: PMC8438811 DOI: 10.1186/s12879-021-06442-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Uptake of HIV self-tests (HIVST) remains low in Europe. We conducted two separate surveys to understand facilitators and barriers to the use of HIVST in two European countries, as part of the EU INTEGRATE Joint Action. In both countries, HIV has been legal since 2016. In Lithuania, where HIVST sales have been low, the survey primarily assessed acceptability whilst in Italy, with better HIVST uptake, usability was the focus. Methods Participants were recruited through community HIV testing sites, and in Lithuania also through social media. In Lithuania, participants self-completed a survey on their testing history, and attitudes toward and experiences with self-testing. In Italy participants performed an HIVST (Mylan Autotest) while being observed by a community health worker (CHW). Both participants and CHW completed a self-administered survey evaluating the experience of the participant. Results In Lithuania, awareness of HIV self-testing (75%) was high among the 138 people who completed the survey. Privacy and confidentiality (70%) was the most common reason to use an HIVST whilst cost was reported as the main barrier by 60%, only 15% were willing to pay the current price. Almost half (42%) were concerned about doing the test incorrectly and 36% preferred that a trained person could discuss their result. Purchasing HIVST at a pharmacy (70%) or online (61%) was favoured and 68% would opt to simultaneously test for other infections. In Italy, 28 people who had never used an HIVST before were observed using one. 43% found the test easy to use but CHWs reported that 36% of participants failed at least one step. The quick result (68%) was the most common reason to use one again, yet the main concerns were the lack of counselling (50%) and reading result alone (32%). Conclusions HIVST are acceptable and usable, however cost is a major barrier. Local and national strategies are needed to increase awareness of and access to HIVST and target HIVST campaigns toward key risk groups such as MSM. Meanwhile, steps can be taken to improve testing instructions and support for self-testers. Offering multiplex testing for other infections would also likely increase uptake.
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Affiliation(s)
- Sophie G Nash
- Blood Safety, Hepatitis, STI and HIV division, National Infection Service, Public Health England, London, UK.
| | - Manuel Maffeo
- Arcigay - Associazione LGBTI Italiana, Bologna, Italy
| | | | - Lella Cosmaro
- Fondazione LILA Milano - Italian League for Fighting AIDS, Milan, Italy
| | | | | | - Qudsia Enayat
- Blood Safety, Hepatitis, STI and HIV division, National Infection Service, Public Health England, London, UK
| | - Valerie Delpech
- Blood Safety, Hepatitis, STI and HIV division, National Infection Service, Public Health England, London, UK
| | - Meaghan Kall
- Blood Safety, Hepatitis, STI and HIV division, National Infection Service, Public Health England, London, UK
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14
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Pai N, Esmail A, Saha Chaudhuri P, Oelofse S, Pretorius M, Marathe G, Daher J, Smallwood M, Karatzas N, Fadul M, de Waal A, Engel N, Zwerling AA, Dheda K. Impact of a personalised, digital, HIV self-testing app-based program on linkages and new infections in the township populations of South Africa. BMJ Glob Health 2021; 6:bmjgh-2021-006032. [PMID: 34475026 PMCID: PMC8413877 DOI: 10.1136/bmjgh-2021-006032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/15/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction Implementation data for digital unsupervised HIV self-testing (HIVST) are sparse. We evaluated the impact of an app-based, personalised, oral HIVST program offered by healthcare workers in Western Cape, South Africa. Methods In a quasirandomised study (n=3095), we recruited consenting adults with undiagnosed HIV infection from township clinics. To the HIVST arm participants (n=1535), we offered a choice of an offsite (home, office or kiosk based), unsupervised digital HIVST program (n=962), or an onsite, clinic-based, supervised digital HIVST program (n=573) with 24/7 linkages services. With propensity score analyses, we compared outcomes (ie, linkages, new HIV infections and test referrals) with conventional HIV testing (ConvHT) arm participants (n=1560), recruited randomly from geographically separated clinics. Results In both arms, participants were young (HIVST vs ConvHT) (mean age: 28.2 years vs 29.2 years), female (65.0% vs 76.0%) and had monthly income <3000 rand (80.8% vs 75%). Participants chose unsupervised HIVST (62.7%) versus supervised HIVST and reported multiple sex partners (10.88% vs 8.7%), exposure to sex workers (1.4% vs 0.2%) and fewer comorbidities (0.9% vs 1.9%). Almost all HIVST participants were linked (unsupervised HIVST (99.7%), supervised HIVST (99.8%) vs ConvHT (98.5%)) (adj RR 1.012; 95% CI 1.005 to 1.018) with new HIV infections: overall HIVST (9%); supervised HIVST (10.9%) and unsupervised HIVST (7.6%) versus ConvHT (6.79%) (adj RR 1.305; 95% CI 1.023 to 1.665); test referrals: 16.7% HIVST versus 3.1% ConvHT (adj RR 5.435; 95% CI 4.024 to 7.340). Conclusions Our flexible, personalised, app-based HIVST program, offered by healthcare workers, successfully linked almost all HIV self-testers, detected new infections and increased referrals to self-test. Data are relevant for digital HIVST initiatives worldwide.
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Affiliation(s)
- Nitika Pai
- Department of Medicine, McGill University, Montreal, Québec, Canada .,Research Institute of McGill University, Montreal, Québec, Canada
| | - Aliasgar Esmail
- South African MRC Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa.,Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Paramita Saha Chaudhuri
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Québec, Canada
| | - Suzette Oelofse
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Marietjie Pretorius
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Gayatri Marathe
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Québec, Canada
| | - Jana Daher
- Research Institute of McGill University, Montreal, Québec, Canada
| | - Megan Smallwood
- Research Institute of McGill University, Montreal, Québec, Canada.,Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Québec, Canada
| | - Nicolaos Karatzas
- Department of Experimental Medicine, McGill University, Montreal, Québec, Canada
| | - Mohammed Fadul
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Anna de Waal
- Research Institute of McGill University, Montreal, Québec, Canada.,Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Québec, Canada
| | - Nora Engel
- Department of Health, Ethics & Society/CAPHRI, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Alice Anne Zwerling
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Keertan Dheda
- South African MRC Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa.,Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, Cape Town, South Africa.,Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
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15
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Hoyos J, Maté T, Guerras JM, Donat M, Agustí C, Kuske M, Fuertes R, Chanos S, Pichon F, Sordo L, Pulido J, Belza MJ. Preference towards HIV Self-Testing above Other Testing Options in a Sample of Men Who Have Sex with Men from Five European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094804. [PMID: 33946300 PMCID: PMC8125199 DOI: 10.3390/ijerph18094804] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/16/2021] [Accepted: 04/27/2021] [Indexed: 12/24/2022]
Abstract
We analyzed men who have sex with men (MSM) from Denmark, Germany, Greece, Portugal and Spain to identify who would choose HIV self-testing as their preferred testing method and assessed their preferred setting to acquire a self-testing kit and to confirm a reactive result. In 2016, we recruited an online sample of 3725 HIV-negative MSM. We used Poisson regression to identify factors associated with choosing self-testing as the preferred testing option. For those choosing it as their preferred option, we assessed the preferred settings to acquire a self-testing kit and to confirm a reactive result. Not being open about one's sexual behaviors with men was associated with choosing self-testing as the preferred option, except in Greece; older age in Greece and Spain; reporting condomless anal intercourses (CAI) in Germany and Portugal; reporting one previous test in Greece; between 2 and 5 in Spain and with having been tested ≥ 12 months ago in Germany, Portugal and Spain. The internet (32.8%) was the preferred place to acquire a self-testing kit and primary care (34.0%) for confirmation purposes. Self-testing was highly valued, especially among individuals who were not open about their sexual behaviors with men. In certain countries, it was also associated with older age, CAI and being undertested.
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Affiliation(s)
- Juan Hoyos
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.H.); (L.S.); (J.P.)
| | - Tomás Maté
- Gerencia de Atención Primaria de Valladolid Este, Gerencia Regional de Salud de Castilla y León (SACYL), 47010 Valladolid, Spain
- Correspondence:
| | - Juan-Miguel Guerras
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marta Donat
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Cristina Agustí
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
- Departament de Salut, Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Generalitat de Catalunya, 08005 Badalona, Spain
| | | | - Ricardo Fuertes
- GAT-Grupo de Ativistas em Tratamentos, 1000-228 Lisboa, Portugal;
| | | | | | - Luis Sordo
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.H.); (L.S.); (J.P.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
| | - José Pulido
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.H.); (L.S.); (J.P.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
| | - María-José Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (J.-M.G.); (C.A.); (M.-J.B.)
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain;
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16
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Samoh N, Peerawaranun P, Jonas KJ, Lim SH, Wickersham JA, Guadamuz TE. Willingness to Use HIV Self-Testing With Online Supervision Among App-Using Young Men Who Have Sex With Men in Bangkok. Sex Transm Dis 2021; 48:e41-e44. [PMID: 32842048 DOI: 10.1097/olq.0000000000001271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT An online assessment among social media-using young men who have sex with men found that 87% were willing to use HIV self-testing with online supervision. Correlates included never tested, having higher numbers of sexual partners, and seeking partners online. HIV self-testing with online supervision may be appropriate for young men who have sex with men who have high risks and may not access venue-based settings.
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Affiliation(s)
- Nattharat Samoh
- From the Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Science and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Pimnara Peerawaranun
- From the Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Science and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Kai J Jonas
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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17
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Hoyos J, Guerras JM, Maté T, Agustí C, Fernández-López L, de la Fuente L, Belza MJ. Opinions Towards Key Operational Aspects for the Implementation of HIV Self-Testing in Spain: A Comparison between Stakeholders and Potential Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041428. [PMID: 33546500 PMCID: PMC7913712 DOI: 10.3390/ijerph18041428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/18/2021] [Accepted: 01/30/2021] [Indexed: 11/16/2022]
Abstract
We assessed previous knowledge about the existence of HIV self-testing of stakeholders in Spain, as well as their personal position towards this methodology. We also assessed their views on potential users’ (PU) opinions towards several key operational aspects surrounding self-testing, and compared them to those expressed by a sample of PU comprised of men who have sex with men. In 2017, we recruited three types of stakeholders: public health professionals and policy makers (PHPPM) (n = 33), clinical providers (n = 290) and community-based/non-governmental organization (CBO/NGO) workers (n = 55). Data on PU (n = 3537) were collected in 2016. Previous knowledge about the existence of self-testing was higher in stakeholders than in PU, but being in favor was less frequent. PUs’ willingness to pay 25–30 euros for a self-test was higher than that which stakeholders considered. According to clinical providers and PHPPM, pharmacies would be PUs’ preferred place to obtain a self-test, which was in line with PUs’ actual choice. CBO/NGO workers on the other hand thought it would be CBO/NGOs. PHPPM and clinical providers considered primary care as PUs’ preferred setting to confirm a reactive self-test and CBO/NGO chose CBO/NGOs, but PUs preferred an HIV/STI testing service or clinic. Stakeholders’ opinions significantly differed from those of PUs. This divergence needs to be brought up to stakeholders as it could vary their position towards self-testing as well as the actions taken in the implementation of a testing option with the potential of increasing testing frequency.
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Affiliation(s)
- Juan Hoyos
- Departamento de Salud Pública y Materno-Infantil, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Juan-Miguel Guerras
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid 28029, Spain
- Correspondence:
| | - Tomás Maté
- Gerencia de Atención Primaria Valladolid Este, 47010 Valladolid, Spain;
| | - Cristina Agustí
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, 08005 Badalona, Spain
| | - Laura Fernández-López
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Centre Estudis Epidemiologics sobre les Infeccions de Transmissio Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, 08005 Badalona, Spain
| | - Luis de la Fuente
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - María-José Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (C.A.); (L.F.-L.); (L.d.l.F.); (M.-J.B.)
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, 28029 Madrid, Spain
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18
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Hoyos J, Guerras JM, Koutentakis K, de la Fuente L, Pulido J, Sordo L, Vallejo F, Belza MJ. The incorporation of HIV self-testing as an exclusive option among men who have sex with men in Spain: results of an online cross-sectional study. BMC Public Health 2020; 20:1865. [PMID: 33276743 PMCID: PMC7718697 DOI: 10.1186/s12889-020-09976-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 11/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background We assessed to what extent HIV self-testing would be incorporated by men who have sex with men (MSM) with previous testing history as their exclusive testing option and describe what actions they would take in the case of obtaining a reactive self-test. Methods We conducted an online survey among Spanish resident MSM recruited mainly in gay dating apps and analyze 6171 ever tested individuals. We used Poisson regression to estimate factors associated with the incorporation of self-testing as the exclusive testing option. Among those who would incorporate self-testing as their exclusive option, we described actions taken if obtaining a reactive self-test by number of tests in the past. Results Nearly half of the participants (48.3%) were > =35 years old, 84.6% were born in Spain, 57.9% had attained a university degree, 55.1% lived in a municipality of ≤500.000 and 86.4% self-identified as homosexual. For 37.2%, self-testing would become their exclusive testing option. The incorporation of self-testing as the exclusive option increased with age 25–34 (PR:1.1, 95%CI:1.0–1.3), 35–44 (PR:1.3, 95%CI:1.2–1.5), 45–49 (PR:1.5, 95%CI:1.3–1.7) and > 50 (PR:1.5, 95%CI:1.3–1.8) and in those who reported unprotected anal intercourse (PR:1.1, 95%CI:1.0–1.2) or having paid for sex (PR:1.2, 95%CI:1.0–1.3) in the last 12 months. It was also associated with having had < 10 HIV test in the past (2–9 tests (PR:1.3, 95%CI:1.1–1.4); 1 test (PR:1.5, 95%CI:1.3–1.7)), and having been tested ≥2 years (PR:1.4, 95%CI:1.3–1.5) or between 1 and 2 years ago (PR:1.1, 95%CI:1.0–1.2). Of participants who would use self-testing exclusively 76.6% would confirm their result in case of obtaining a reactive self-test and only 6.1% wouldn’t know how to react. Only one individual expressed that he would do nothing at all. Conclusion HIV self-testing could become the exclusive testing option for more than a third of our participants. It was chosen as the exclusive option especially by older, at risk and under-tested MSM. Self-testing strategies need to especially consider the linkage to care process. In this sense, only a small fraction would not know how to react and virtually nobody reported taking no action if obtaining a reactive result. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09976-9.
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Affiliation(s)
- J Hoyos
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
| | - J M Guerras
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain. .,National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain.
| | - K Koutentakis
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - L de la Fuente
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain.,National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - J Pulido
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
| | - L Sordo
- Department of Public Health and Maternal and Child Health, Complutense University of Madrid, Madrid, Spain.,Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain
| | - F Vallejo
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain.,Department of Biostatistics and Epidemiology, National School of Health, Carlos III Health Institute, Madrid, Spain
| | - M J Belza
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain.,Department of Biostatistics and Epidemiology, National School of Health, Carlos III Health Institute, Madrid, Spain
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Balán IC, Lopez-Rios J, Giguere R, Lentz C, Dolezal C, Cruz Torres C, Brown W, Crespo R, Sheinfil A, Tagliaferri Rael C, Febo I, Carballo-Diéguez A. Then We Looked at His Results: Men Who Have Sex With Men from New York City and Puerto Rico Report Their Sexual Partner's Reactions to Receiving Reactive HIV Self-Test Results. AIDS Behav 2020; 24:2597-2605. [PMID: 32078078 DOI: 10.1007/s10461-020-02816-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Secondary distribution of HIV self-tests to sexual partners is acceptable but concerns remain about reactions if a partner tests HIV-positive. We report on 14 participants whose sexual partners tested HIV-positive during the "I'll Show You Mine" Study, a randomized controlled trial (N = 272) of HIV self- and partner-testing among men who have sex with men (MSM) and transgender women (TGW). All 14 were MSM and racial/ethnic minorities, mean age was 36.6 years; 86% were gay-identified. Twenty-four partners tested positive; about half were new partners. Six participants had multiple partners test positive. During in-depth interviews with 10 of these participants, they reported their partners' reactions ranged from tearful and worried among those whose result was unexpected, to resignation among those who suspected a positive result, to nonchalance among partners who participants concluded knew of their HIV infection. After testing, some HIV-positive partners disclosed prior knowledge of their status. No partner reacted violently. Participants typically comforted their partners and encouraged confirmatory testing. Four participants had anal intercourse with partners who tested positive. Participants and partners were able to effectively handle situations in which the partner tested HIV-positive.
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