Acceptability of Peer-Delivered HIV Testing and Counselling Among Men Who Have Sex with Men (MSM) and Transgender Women (TW) in Myanmar

Abstract

Men who have sex with men (MSM) and transgender women (TW) are a priority population for HIV prevention in Myanmar but report sub-optimal HIV testing frequency. Previous studies have shown that peer involvement in HIV testing can normalize stigmatized sexualities and reduce barriers to testing. We explored the acceptability of peer-delivered HIV testing among 425 undiagnosed MSM and TW in Yangon and Mandalay. An overwhelming majority of participants (86%) reported being 'comfortable/very comfortable' with peer-delivered HIV testing. Logistic regression identified reporting sexual identity as Apone [adjusted odds ratio (aOR) 3.8; 95% CI 1.2-11.7], recent HIV testing (aOR 3.1; 95% CI 1.4-6.5), reporting a high likelihood of HIV acquisition (aOR 3.6; 95% CI 1.7-7.6), and reporting ≥ 5 casual partners in the past 3 months (aOR 0.2; 95% CI 0.1-0.6) as associated with peer-delivered HIV testing acceptability. Given ongoing HIV vulnerability among MSM and TW in Myanmar, peer-delivered testing may offer prevention benefits by increasing testing rates and identifying undiagnosed infection earlier.

HIV incidence and factors associated with testing positive for HIV among men who have sex with men and transgender women in Myanmar: data from community‐based HIV testing services

“…Awareness of sexual orientation is an important precursor to provider-initiated HIV testing [36], and non-disclosure of sexual behaviours may hinder the provision of relevant and tailored sexual health information, including assessments of eligibility for biomedical HIV prevention options. Our findings corroborate reports of differential levels of HIV vulnerability and access to HIV services among sexual identities in Myanmar [4,11,23,29] and support the need for HIV prevention strategies tailored to the specific needs of MSM and TW sub -populations.…”

“…While MSM and TW in Myanmar self‐report high levels of regular HIV testing , the dissonance with data presented in this paper may suggest an overestimation of testing behaviours among MSM or TW, or ongoing barriers to enacting testing aspirations. Documented barriers to HIV testing among MSM and TW in Myanmar include experiences of stigma and discrimination, perceived unfriendliness of government or mainstream health staff, and avoidance of HIV prevention services manifestly catering for MSM and TW among those for whom concealment of sexual identity is a key priority .…”

“…In particular, peer‐delivered testing and HIV self‐testing have demonstrated utility in increasing HIV testing uptake among stigmatised populations in other Asian settings . Both models are backed by a documented willingness among MSM and TW to access such services and a supportive policy environment that is conducive to the introduction of novel testing modalities in Myanmar . These factors provide an opportunity to diversify testing delivery approaches as a key strategy to enhance regular HIV testing, and should be considered alongside condom reinforcement programs and consideration of HIV pre‐exposure prophylaxis (PrEP) (undertaking PrEP demonstration projects is currently recommended in the national strategic plan but yet to occur) .…”

“…However, recent scale‐up of HIV programs, particularly decentralised HIV testing services run by local and international non‐government organisations (NGOs), has allowed for new models of community‐based and peer‐staffed HIV services. These services are now a common feature of Myanmar's HIV response and aim to promote greater engagement of key populations by circumventing known psycho‐social barriers to testing in line with Myanmar's National Strategic Plan on HIV .…”

Feasibility and Acceptability of a Behavioral Group Support Intervention Among Transgender Women: A Sexual and Mental Health Mixed-Methods Pilot Study in Beirut, Lebanon

“…Existing literature emphasizes the importance of peer involvement in health promoting strategies among trans women, including peer-delivered HIV testing and counseling (Veronese et al, 2018) and peer education in HIV prevention (Silva-Santisteban, Eng, de la Iglesia, Falistocco, & Mazin, 2016). Although only half of participants in the formative phase of the study indicated the desire for a peer (trans woman) facilitator for the intervention, the feedback provided about the facilitator’s attentiveness, mastery, articulation, and communication skills were overwhelmingly positive.…”