Acceptability of HIV self-testing is low among men who have sex with men who have not tested for HIV: a study with respondent-driven sampling in Brazil

Abstract

Background Brazil has many people living with HIV (PLWH) who are unaware of their serostatus. The public health system has recently added HIV self-testing (HIVST) for key populations such as men who have sex with men (MSM). This study estimates HIVST acceptability among Brazilian MSM and explores factors associated with acceptability among MSM who have never tested for HIV or who had a previous negative result. Methods Respondent-driven sampling (RDS) was used to recruit 4176 MSM in 12 Brazilian cities in 2016 to this biological and behavioral surveillance study. We excluded from this analysis all MSM who were aware of their positive HIV serostatus. Descriptive, bivariate and multivariate analyses were conducted. Overall proportions were weighted with Gile’s estimator in RDS Analyst software and 95% confidence intervals were calculated. The analyses of HIVST acceptability were stratified by prior HIV testing (never or one or more times). Results For this analysis, 3605 MSM were included. The acceptability of HIVST was 49.1%, lower among those who had never tested for HIV (42.7%) compared to those who had a previous HIV negative test (50.1%). In the subgroup of MSM who had never tested for HIV, those who reported discrimination or who had a medical appointment in the last 12 months reported higher HIVST acceptability. Among MSM who had a previous negative HIV test, only those reporting condomless receptive anal sex reported higher HIVST acceptability. In addition, we observed that high levels of knowledge of HIV/AIDS, taking part in lesbian, gay, bisexual, and transgender nongovernmental organizations (LGBT-NGO), or complete secondary or incomplete higher undergraduate education reported higher acceptability. Conclusions The acceptability of HIVST was low among MSM, especially among those who never tested for HIV. Given access to HIVST in Brazil, we point to the need for programs that enhance promotion of testing addressed to MSM.

Determinants of Recent HIV Self-Testing Uptake Among Men Who Have Sex With Men in Jiangsu Province, China: An Online Cross-Sectional Survey

“…According to our findings, only 65.9% of MSM in our study had ever self-tested for HIV. Our observed rate is higher than the rates found in a study conducted in the province in 2014 (26.2%) ( 24 ), and in recent studies conducted in Brazil (49.1%) ( 13 ) and China ( 25 ). Considering the limitations of facility-based testing and the impact of COVID-19, upscaling HIVST uptake among Chinese MSM will require more efforts.…”

“…In addition, many studies have found HIVST acceptable to various marginalized populations (including MSM) and feasible in multiple settings (11)(12)(13)(14). For MSM who have never tested for HIV, HIVST may represent a suitable option as it offers privacy, confidentiality, and is easy to use (15,16).…”

Pre-exposure prophylaxis use, HIV knowledge, and internalized homonegativity among men who have sex with men in Brazil: A cross-sectional study

“…There is growing recognition that knowledge about HIV prevention modalities facilitates their uptake. 14 Research has shown that those with greater HIV knowledge are more likely to engage with prevention services, 15 and lack of understanding about the efficacy and/or side effects of PrEP may lead to decreased willingness to use it. 16 Another factor known to impact engagement with HIV prevention is internalized homonegativity, which refers to gay or homosexual MSM directing societal stigma, discrimination, or negative perceptions about homosexuality toward themselves.…”

Development and Evaluation of Short-Form Measures of the HIV/AIDS Knowledge Assessment Tool Among Sexual and Gender Minorities in Brazil: Cross-sectional Study

“…This lower HIV knowledge may be a contributing factor to higher vulnerability to HIV infection. Indeed, multiple studies using different measures of HIV-related knowledge have shown a link between testing and knowledge with a gradient of increased knowledge as you move from the categories of never tested to HIV-negative and HIV-positive [ 28 , 29 , 56 ]. One hypothesis for this finding is that exposure to the health care setting and counseling during testing may increase HIV-specific knowledge.…”