HIV Self-testing Relatively Uncommon Among MSM in Urban Areas

In 2017, HIV self-testing (HIVST) was relatively uncommon among men who have sex with men (MSM) living in US urban areas, according to research published in JAMA Network Open.

Specifically, of 6563 MSM, only 506 (7.7%) reported HIVST in the past year.

“HIVST may not be reaching those with lower socioeconomic status or who have not disclosed their sexual identity,” the authors said. “The findings of this study suggest that efforts to increase HIVST should focus on engaging underserved and vulnerable subgroups of MSM.”

To come to this finding, the authors collected data from the 2017 National HIV Behavioral Surveillance system. This system collected data on HIV testing, risk factors, and receipt of prevention services using venue-based sampling methods at 588 venues in 23 urban areas in the United States and Puerto Rico. Adult cisgender MSM with either negative or unknown HIV status who received HIV testing within the past 12 months of data collection were included.

Data for the study were collected between June 4, 2017, and December 22, 2017, and analyzed between October 23, 2020, and August 20, 2021.

Of the 506 MSM who reported HIVST, the median (IQR) age was 29 (25-35) years. The authors noted that 37.9% were non-Hispanic White and 52.8% had completed college.

Additionally, 1 individual who reported self-testing also reported seroconverting in the past 12 months, compared with 114 who did not self-test who received an HIV diagnosis in the past 12 months. During the survey period, another 10 MSM who self-tested and 162 who did not self-test received an HIV diagnosis.

Study participants who disclosed their sexual orientation were more than 10 times more likely to self-test compared with those who did not disclose their sexual orientation (adjusted prevalence ratio [aPR], 10.27; 95% CI, 3.45-30.60; P < .001).

HIVST was also higher among individuals with perceived discrimination who said people in their community would not be friends with people with HIV (aPR, 1.53; 95% CI, 1.09-2.13; P = .01), but lower among individuals who reported experiencing verbal discrimination due to their sexual identity (aPR, 0.80; 95% CI, 0.67-0.96; P = .02). The authors did not observe significant differences with other measures of discrimination or stigma.

Additionally, HIVST was associated with younger age (aPR, 0.74; 95% CI, 0.66-0.84; P < .001), higher educational level (aPR, 1.20; 95% CI, 1.04-1.37; P = .01), and higher income level (aPR, 1.18; 95% CI, 1.04-1.32; P = .009).

According to the authors, these associations raise concerns regarding how HIVST is reaching—or not reaching—MSM experiencing poverty or with lower socioeconomic status.

“Although clinical trials have demonstrated benefits to offering HIVST, clinical trials present artificial environments outside of clinical settings and provided self-test kits free of charge,” they said. “Prior research has suggested that price, marketing, and distribution strategies may have a substantial effect on uptake of HIVST.”

The authors found no association between HIVST and anal sex without protection (aPR, 0.96; 95% CI, 0.88-1.06, P = .88), sexually transmitted infections (aPR, 0.96; 95% CI, 0.70-1.30; P = .77), or HIV pre-exposure prophylaxis (PrEP) use (aPR, 0.99; 95% CI, 0.75-1.30; P = .92) among MSM.

It should be noted that these findings are specific to MSM in certain urban areas in 2017, and may not be representative of HIVST among MSM across the country.

Reference

Bien-Gund CH, Shaw PA, Agnew-Brune C, et al. HIV self-testing and risk behaviors among men who have sex with men in 23 US cities, 2017. JAMA Netw Open. 2022;5(12):e2247540. doi:10.1001/jamanetworkopen.2022.47540