“Just Because It's Out There, People Aren't Going to Use It.” HIV Self-Testing Among Young, Black MSM, and Transgender Women

Abstract

HIV disproportionately affects young black MSM and transgender women in the US. Increasing HIV testing rates among these populations is a critical public health goal. Although HIV self-tests are commercially available, there is a need to better understand access to and uptake of HIV self-testing among this population. Here, we report results of a qualitative study of 30 young black MSM and transgender women residing in the New York City area to understand facilitators of and barriers to a range of HIV testing approaches, including self-testing. Mean age was 23.7 years (SD = 3.4). Over half (54%) had some college or an associate's degree, yet 37% had an annual personal income of less than $10,000 per year. Most (64%) participants had tested in the past 6 months; venues included community health/free clinics, medical offices, mobile testing units, hospitals, emergency departments, and research sites. Just one participant reported ever using a commercially available HIV self-test. Facilitators of self-testing included convenience, control, and privacy, particularly as compared to venue-based testing. Barriers to self-testing included the cost of the test, anxiety regarding accessing the test, concerns around correct test operation, and lack of support if a test result is positive. Participants indicated that instruction in correct test operation and social support in the event of a positive test result may increase the likelihood that they would use the self-test. Alongside developing new approaches to HIV prevention, developing ways to increase HIV self-testing is a public health priority for young, black MSM, and transgender women.

‘If I had not taken it [HIVST kit] home, my husband would not have come to the facility to test for HIV’: HIV self-testing perceptions, delivery strategies, and post-test experiences among pregnant women and their male partners in Central Uganda

“…These consequences included fears of marital disruption and suicidal ideation [17] due to the absence of pre- or post-test counseling. Similar fears have been documented in other studies [18,19] especially with regard to fears of what could happen in the home in the event that one of the partners is HIV-positive, in the absence of post-test counseling. To deal with these fears, we provided adequate preparation to improve the women’s technical competencies and negotiation efficacy to improve their ability to deliver the kits as well as encourage their partners to test alone or together with them.…”

Risk Factors Associated With Repeated HIV Testing Among Internet-Using Men Who Have Sex With Men

“…19–21 Moreover, at-home testing is acceptable among internet-using MSM: a study of 6,163 MSM recruited online found that 62% of participants reported being very likely and 20% likely to accept a free anonymous at-home HIV test as part of future online prevention studies. 12 …”

Perceived Cost Advantages and Disadvantages of Purchasing HIV Self-Testing Kits among Urban Tanzanian Men: An Inductive Content Analysis

“…For example, research has shown that HIV diagnoses made in non-clinical settings, such as mobile vans or peer networks, are less effective in linking newly-identified cases to HIV care and treatment [51]. In our study, a misperceived advantage of HIVST among a few men was the omitted need for follow-up clinical visits.…”

“…From a consumer perspective, kit pricing is a reasonable concern. Previous research has shown that the unit cost of an HIVST kit accounts for half of the total costs of HIVST for consumers [28] and that kit price is a barrier to HIVST acceptability [51]. Despite the appeal of HIVST in reducing costs related to clinic travel and waiting time, addressing cost concerns of the price of HIVST by providing free or subsidized HIVST kits may be necessary to fully reduce testing barriers in low-income men.…”

“…However, few studies have investigated consumer views on the financial advantages and disadvantages of selfperforming HIV tests, beyond the price of the test itself. The available economic studies relating to HIVST have primarily focused on willingness to pay for HIVST [21], economic characteristics associated with HIVST, such as employment and income [49][50][51], and costeffectiveness of HIVST from the perspective of health systems [43,52,53]. However, less is known regarding perceived financial trade-offs of HIVST among economicallydisadvantaged individuals, particularly sub-Saharan African men, who have high risk of HIV and are less likely to test using current models [10,54].…”