Self-Testing for HIV Could Promote Risk Behaviors in MSM

Risk behaviors may be promoted in men who have sex with men (MSM) when they are able to self-test for HIV (HIVST), according to a study published in Frontiers of Public Health. This could encourage the customization of HIVST promotion programs to better address both reporting of HIV and any risk behaviors.

MSM more often display risk behaviors that keep them at high risk of HIV, making up approximately 17% of new HIV infections globally. The only way to identify the people who are infected with HIV is to test, which makes expanding testing vital to reducing the incidence of HIV. HIVST has been recommended by the World Health Organization to expand testing of HIV but risk behaviors in MSM who use HIVST have come under scrutiny. This study aimed to assess how much HIVST affects risk behaviors in MSM.

Young man holding HIV awareness ribbon | Image credit: Krakenimages.com - stock.adobe.com

The study was conducted in Qingdao City in China due to the increasing prevalence of HIV in MSM in the city, the cooperation of the local Center for Disease Control and Prevention, and the non-governmental organizations (NGOs) having close contact with MSMs in the area.

This study used a mixed-methods design to combine both quantitative and qualitative designs. There were 3 parts to the study as a baseline survey, a retrospective survey, and a follow-up visit were all conducted. Participants were enrolled between April and August 2021. All participants were asked to complete the baseline and retrospective surveys to collect information on their feelings in the moment and before using HIVST. Behavioral information was collected during the follow-up, which took place 6 months later. NGOs kept up active communication with all participants to encourage future visits.

Participants were eligible if they were assigned male at birth, were aged 18 years or older, lived in Qingdao, used HIVST in the last 6 months, were able to provide written consent, had sex with a man in the previous 6 months, and had tested HIV negative at baseline. Interviews were done with all MSM who completed their follow-up visit. All data were collected face-to-face.

There were 327 participants who completed the follow-up survey. The participants were primarily MSM who were aged younger than 40 years, were unmarried, were employed full-time, were homosexual, and had an education of college or higher.

Recreational drug abuse (20.7% vs 21.5%), commercial sex (14.6% vs 17.3%), and unprotected anal sex (95.9% vs 96.6%) increased in MSM after HIVST compared with before. There was a decrease in casual sex (99.0% vs 98.0%) and group sex (88.0% vs 87.3%) when comparing before with after HIVST. The proportion of MSM who participated in the risk behaviors increased after HIVST compared with before, with recreational drugs abuse (RR, 1.198; 95% CI, 1.057-1.357), commercial sex (RR, 1.263; 95% CI, 1.071-1.491), and unprotected anal sex (RR, 1.014; 95% CI, 1.001-1.028) being the most statistically significant.

There were 18 MSM who were interviewed. MSM believed that their risk of HIV decreased after a negative result on a HIVST. Some MSM stated that they took the test in order to engage in the risk behaviors. Others said that it didn’t change their behavior due to their married status.

There were some limitations to this study. Non-governmental organizations (NGOs) were used to recruit participants, which led to MSM who were more connected to NGOs being included; these men were likely more knowledgeable about HIVST and the overall increase in risk behaviors could be underestimated. A strict control group was not set up for this study which means the changes in risk behaviors may not be exclusively related to the use of HIVST.

The researchers concluded that HIVST could be a reason for decreased risk awareness in MSM. Future studies should focus on the reason for this trend and should focus on tailored promotion of HIVST to address the issue.

Reference

Su R, Liu Y, Li P, et al. The impact of HIV self-testing on risk behaviors among men who have sex with men: a mixed-methods study. Front Public Health. 2024;12:1369931. doi:10.3389/fpubh.2024.1369931