Previous and future use of HIV self-testing: a survey of Australian gay and bisexual men
Garrett Prestage A B E , Iryna Zablotska A , Ben Bavinton A , Andrew Grulich A , Phillip Keen A , Dean Murphy C D , Graham Brown B , Jack Bradley A , Martin Holt C and Rebecca Guy AA Kirby Institute, University of New South Wales, Kensington, NSW 2052, Australia.
B Australian Research Centre in Sex Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia.
C Centre for Social Research and Health, University of New South Wales, Kensington, NSW 2052, Australia.
D Australian Federation of AIDS Organisations, PO BOX 51, Newtown, NSW 2042, Australia.
E Corresponding author. Email: gprestage@kirby.unsw.edu.au
Sexual Health 13(1) 55-62 https://doi.org/10.1071/SH15099
Submitted: 17 May 2015 Accepted: 10 September 2015 Published: 27 October 2015
Abstract
Background: The awareness and previous and intended use of HIV self-testing (HST), and the associated factors, among Australian gay and bisexual men (GBM) was investigated. Methods: An online cross-sectional survey was conducted in Australia during 2012. Of 1410 respondents, 559 non-HIV-positive men answered questions about HST. Results: Men reported reasons for having avoided or delayed HIV testing, most of which could be broadly categorised as: the inconvenience of current testing procedures; concerns about privacy; and a belief that they had not done anything risky. Over one-third of men (39.7%) were aware that HST was available internationally, with 1.6% having accessed HST through online purchase. The majority of men in the study indicated that they would be ‘likely’ (36.5%) or ‘very likely’ (34.3%) to use HST if it was available in Australia. Also, 36.7% indicated they would test partners they met at sex-on-site venues, and 73.2% would test partners with whom they were already acquainted. Nearly half (47.6%) indicated that having the capacity to test themselves at home would likely increase their testing frequency. Men who had engaged in unprotected anal intercourse, who were not gay-identified, and who indicated inconvenience issues with using clinic-based HIV testing were more likely to indicate a willingness to use HST. Many men indicated they would be likely to offer HST to at least some of their sex partners. Conclusion: Many GBM who engage in HIV risk behaviours would appreciate HST, and may be encouraged to test more often, as it may alleviate their concerns about testing.
Additional keywords: barriers to testing, home testing, men who have sex with men, sexual risk.
References
[1] Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2013. Sydney: The Kirby Institute, University of New South Wales; 2014.[2] Pedrana AE, Hellard ME, Wilson K, Guy R, Stoove M. High rates of undiagnosed HIV infections in a community sample of gay men in Melbourne, Australia. J Acquir Immune Defic Syndr 2012; 59 94–9.
| High rates of undiagnosed HIV infections in a community sample of gay men in Melbourne, Australia.Crossref | GoogleScholarGoogle Scholar | 21992925PubMed |
[3] Birrell F, Staunton S, Debattista J, Roudenko J, Rutkin W, Davis C. Pilot of non-invasive (oral fluid) testing for HIV within a community setting. Sex Health 2010; 7 11–6.
| Pilot of non-invasive (oral fluid) testing for HIV within a community setting.Crossref | GoogleScholarGoogle Scholar | 20152090PubMed |
[4] Lemoh C, Guy R, Yohannes K, Lewis J, Street A, Biggs B, Hellard M. Delayed diagnosis of HIV infection in Victoria 1994 to 2006. Sex Health 2009; 6 117–22.
| Delayed diagnosis of HIV infection in Victoria 1994 to 2006.Crossref | GoogleScholarGoogle Scholar | 19457290PubMed |
[5] Holt M, Hull P, Lea T, Guy R, Bourne C, Prestage G. Comprehensive testing for, and diagnosis of, sexually transmissible infections among Australian gay and bisexual men: findings from repeated, cross-sectional behavioural surveillance, 2003–2012. Sex Transm Infect 2014; 90 208–15.
| Comprehensive testing for, and diagnosis of, sexually transmissible infections among Australian gay and bisexual men: findings from repeated, cross-sectional behavioural surveillance, 2003–2012.Crossref | GoogleScholarGoogle Scholar | 24234070PubMed |
[6] Guy R, Goller JL, Spelman T, El-Hayek C, Gold J, Lim M, Leslie D, Tee BK, Roth N, Anderson J, Fairley CK, Kaldor J, Hellard M. Does the frequency of HIV and STI testing among men who have sex with men in primary care adhere with Australian guidelines? Sex Transm Infect 2010; 86 371–6.
| Does the frequency of HIV and STI testing among men who have sex with men in primary care adhere with Australian guidelines?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3cflsVyjug%3D%3D&md5=a186d5775e6b9949ca99c14631d1a2f4CAS | 20460263PubMed |
[7] STIs In Gay Men Action Group. STI testing guidelines for men who have sex with men (MSM). Sydney: STIs In Gay Men Action Group; 2010.
[8] Bavinton BR, Brown G, Hurley M, Bradley J, Keen P, Conway D, Guy R, Grulich AE, Prestage G. Which gay men would increase their frequency of HIV testing with home self-testing? AIDS Behav 2013; 17 2084–92.
| Which gay men would increase their frequency of HIV testing with home self-testing?Crossref | GoogleScholarGoogle Scholar | 23525790PubMed |
[9] Wand H, Yan P, Wilson D, McDonald A, Middleton M, Kaldor J, Law M. Increasing HIV transmission through male homosexual and heterosexual contact in Australia: results from an extended back‐projection approach. HIV Med 2010; 11 395–403.
| 1:STN:280:DC%2BC3cnntVSnsw%3D%3D&md5=5b0c95d5cb11a69db4e3a9e169a9769aCAS | 20136660PubMed |
[10] Zablotska I, Holt M, de Wit J, McKechnie M, Mao L, Prestage G. Gay men who are not getting tested for HIV. AIDS Behav 2012; 16 1887–94.
| Gay men who are not getting tested for HIV.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38rosVyltA%3D%3D&md5=422309f4462162c97e42f6b7ac71e8efCAS | 22538372PubMed |
[11] Gray RT, Prestage GP, Down I, Ghaus MH, Hoare A, Bradley J, Wilson DP. Increased HIV testing will modestly reduce HIV incidence among gay men in NSW and would be acceptable if HIV testing becomes convenient. PLoS One 2013; 8 e55449
| Increased HIV testing will modestly reduce HIV incidence among gay men in NSW and would be acceptable if HIV testing becomes convenient.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXjsVarsLw%3D&md5=82fe023a67028602b8e46e8fbe433fa0CAS | 23457470PubMed |
[12] Franco-Paredes C, Tellez I, del Rio C. Rapid HIV testing: a review of the literature and implications for the clinician. Curr HIV/AIDS Rep 2006; 3 169–75.
| Rapid HIV testing: a review of the literature and implications for the clinician.Crossref | GoogleScholarGoogle Scholar | 17032576PubMed |
[13] Commonwealth Department of Health and Ageing. National HIV Strategy, 2010. Canberra: Commonwealth Department of Health and Ageing; 2011.
[14] Therapeutic Goods Administration. Announcement regarding the licensing of the Determine Combo rapid test. Canberra: Therapeutic Goods Administration. Available online at: https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=232957&agid=(PrintDetailsPublic)&actionid=1 [verified 6 October 2015].
[15] National HIV Testing Policy Expert Reference Committee. National HIV Testing Policy, 2011. Canberra: Commonwealth Department of Health and Ageing; 2011. Available online at http://testingportal.ashm.org.au/resources/Australian_National_HIV_Testing_Policy_v1-1. pdf (through the Australian Society for HIV Medicine website) [verified 22 July 2015].
[16] U.S. Food and Drug Administration. FDA approves first over-the-counter home-use rapid HIV test. Silver Spring, MD: US Food & Drug Administration; 2012.
[17] Cooper C. HIV home testing kits will be available on NHS after law change. UK Independent, 14 August 2013. Available online at: http://www.independent.co.uk/life-style/health-and-families/health-news/hiv-hometesting-kits-will-be-available-on-nhs-after-law-change-8762152.html [verified 6 October 2015].
[18] Napierala Mavedzenge S, Baggaley R, Corbett EL. A review of self-testing for HIV: research and policy priorities in a new era of HIV prevention. Clin Infect Dis 2013; 57 126–38.
| A review of self-testing for HIV: research and policy priorities in a new era of HIV prevention.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXptFelt7c%3D&md5=abfa6aa01898cfea3eb1aa05e188cb39CAS | 23487385PubMed |
[19] Krause J, Subklew-Sehume F, Kenyon C, Colebunders R. Acceptability of HIV self-testing: a systematic literature review. BMC Public Health 2013; 13 735
| Acceptability of HIV self-testing: a systematic literature review.Crossref | GoogleScholarGoogle Scholar | 23924387PubMed |
[20] Prestage G, Brown G, Keen P. Barriers to HIV testing among Australian gay men. Sex Health 2012; 9 453–8.
| Barriers to HIV testing among Australian gay men.Crossref | GoogleScholarGoogle Scholar | 23380195PubMed |
[21] de Wit J, Adam P. To test or not to test: psychosocial barriers to HIV testing in high‐income countries. HIV Med 2008; 9 20–2.
| To test or not to test: psychosocial barriers to HIV testing in high‐income countries.Crossref | GoogleScholarGoogle Scholar | 18557865PubMed |
[22] Koelmeyer R, Grierson J, Pitts M. Motivations for and barriers to HIV testing in Australia. Melbourne: Australian Research Centre in Sex, Health and Society, La Trobe University; 2011.
[23] Greacen T, Friboulet D, Fugon L, Hefez S, Lorente N, Spire B. Access to and use of unauthorised online HIV self-tests by internet-using French-speaking men who have sex with men. Sex Transm Infect 2012; 88 368–74.
| Access to and use of unauthorised online HIV self-tests by internet-using French-speaking men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 22436195PubMed |
[24] Chen MY, Bilardi JE, Lee D, Cummings R, Bush M, Fairley CK. Australian men who have sex with men prefer rapid oral HIV testing over conventional blood testing for HIV. Int J STD AIDS 2010; 21 428–30.
| Australian men who have sex with men prefer rapid oral HIV testing over conventional blood testing for HIV.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3cnltFGltA%3D%3D&md5=3d25277ca465a481bf45a88d44ccc16fCAS | 20606224PubMed |
[25] MacKellar DA, Hou SI, Whalen CC, Samuelson K, Sanchez T, Smith A, Denson D, Lansky A, Sullivan P, WHBS Study Group Reasons for not HIV testing, testing intentions, and potential use of an over-the-counter rapid HIV test in an internet sample of men who have sex with men who have never tested for HIV. Sex Transm Dis 2011; 38 419–28.
| Reasons for not HIV testing, testing intentions, and potential use of an over-the-counter rapid HIV test in an internet sample of men who have sex with men who have never tested for HIV.Crossref | GoogleScholarGoogle Scholar | 21183863PubMed |
[26] Mao L, Crawford J, Van De Ven P, Prestage G, Grulich A, Kaldor J, Kippax S. Differences between men who report frequent, occasional or no unprotected anal intercourse with casual partners among a cohort of HIV-seronegative gay men in Sydney, Australia. AIDS Care 2006; 18 942–51.
| Differences between men who report frequent, occasional or no unprotected anal intercourse with casual partners among a cohort of HIV-seronegative gay men in Sydney, Australia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28rotVSltw%3D%3D&md5=223f005b9a4dbeda8132c219b6cc4cccCAS | 17012084PubMed |
[27] Pai NP, Sharma J, Shivkumar S, Pillay S, Vadnais C, Joseph L, Dheda K, Peeling RW. Supervised and unsupervised self-testing for HIV in high-and low-risk populations: a systematic review. PLoS Med 2013; 10 e1001414
| Supervised and unsupervised self-testing for HIV in high-and low-risk populations: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[28] U.S. Food and Drug Administration. First rapid home-use HIV kit approved for self-testing. Silver Spring, MD: FDA Consumer Health Information; 2014. Available online at: http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM311690.pdf [verified 22 July 2015].
[29] Thornton AC, Delpech V, Kall MM, Nardone A. HIV testing in community settings in resource‐rich countries: a systematic review of the evidence. HIV Med 2012; 13 416–26.
| HIV testing in community settings in resource‐rich countries: a systematic review of the evidence.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38vmsFGntw%3D%3D&md5=4755747db9f242a7b21c94c111935108CAS | 22413900PubMed |
[30] Yang M, Prestage G, Maycock B, Brown G, de Wit J, McKechnie M, Guy R, Keen P, Fairley CK, Zablotska IB. The acceptability of different HIV testing approaches: cross-sectional study among GMSM in Australia. Sex Transm Infect 2014; 90 592–5.
| The acceptability of different HIV testing approaches: cross-sectional study among GMSM in Australia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2cbhsFehuw%3D%3D&md5=326027a5acd8bf1b56d471d61a818c8bCAS | 25015651PubMed |
[31] Colyer S. Home HIV tests closer. Sydney: MJAInSight; 2015. Available online at: https://www.mja.com.au/insight/2015/8/home-hiv-tests-closer?0=ip_login_no_cache%3D575048629239f25f558d010c91a2f315 [verified 22 July 2015].
[32] Carballo-Diéguez A, Frasca T, Dolezal C, Balan I. Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners? J Sex Res 2012; 49 379–87.
| Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners?Crossref | GoogleScholarGoogle Scholar | 22293029PubMed |
[33] Balan IC, Carballo-Diéguez A, Frasca T, Dolezal C, Ibitoye M. The impact of rapid HIV home test use with sexual partners on subsequent sexual behavior among men who have sex with men. AIDS Behav 2014; 18 254–62.
| The impact of rapid HIV home test use with sexual partners on subsequent sexual behavior among men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 23657758PubMed |
[34] Zablotska IB, Holt M, Prestage GP. Changes in gay men’s participation in gay community life: implications for HIV surveillance and research. AIDS Behav 2012; 16 669–75.
| Changes in gay men’s participation in gay community life: implications for HIV surveillance and research.Crossref | GoogleScholarGoogle Scholar | 21424273PubMed |
[35] Prestage G, Mao L, McGuigan D, Crawford J, Kippax S, Kaldor J, Grulich AE. HIV risk and communication between regular partners in a cohort of HIV-negative gay men. AIDS Care 2006; 18 166–72.
| HIV risk and communication between regular partners in a cohort of HIV-negative gay men.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28%2FpvV2huw%3D%3D&md5=ce5188272b13fc6a74aade5b9b7e0352CAS | 16338775PubMed |
[36] Holt M, Rawstorne P, Wilkinson J, Worth H, Bittman M, Kippax S. HIV testing, gay community involvement and internet use: social and behavioural correlates of HIV testing among Australian men who have sex with men. AIDS Behav 2012; 16 13–22..
| HIV testing, gay community involvement and internet use: social and behavioural correlates of HIV testing among Australian men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC387jt1GjtQ%3D%3D&md5=fa54b05e4d3378e2a30293797e84cf65CAS | 21213035PubMed |