Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay, Bisexual, and Other Men Who Have Sex With Men in Australia

Abstract

BackgroundIn Australia, undiagnosed HIV rates are much higher among migrant gay, bisexual, or other men who have sex with men (GBMSM) than Australian-born GBMSM. HIV self-testing is a promising tool to overcome barriers to HIV testing and improve HIV testing uptake among migrant GBMSM. We compared the preferences for HIV testing services, including HIV self-testing, among migrant and Australian-born GBMSM.MethodsPreferences were assessed via two discrete choice experiments (DCEs). Participants were recruited between December 2017 and January 2018 using online and offline advertising and randomly assigned to complete one of two online DCE surveys. Migrant GBMSM were classified as being born in a country with a reciprocal healthcare agreement (RHCA) with Australia (providing free or subsided health care) or not. Latent class analysis and mixed logit models were used to explore heterogeneity in preferences.FindingsWe recruited 1,606 GBMSM, including 583 migrant men of whom 419 (72%) were born in non-RHCA countries. Most participants preferred a free or cheap oral test with higher accuracy and a shorter window period to facilitate early detection of infections. Cost was more important for men born in non-RHCA countries than for men from RHCA countries or Australia. All groups preferred accessing kits through online distributers or off the shelf purchasing from pharmacies. Men born in RHCA countries least preferred accessing HIV self-testing kits from a medical clinic, while more than half of men from non-RHCA countries most preferred sourcing kits from a clinic. Sex-on-premises venues were the least preferred location to access test kits among all groups. In addition, two latent class analyses explored heterogeneity in preferences among men from non-RHCA countries and we found four latent classes for HIV testing services and two latent classes for HIVST distribution.InterpretationOur findings emphasise the need for high-performing and low-cost HIV self-testing kits that are accessible from a variety of distribution points as a component of Australia's HIV response, especially for those who do not have access to free or subsidised health care in Australia.

The impact of social connections and discrimination to HIV risk among Asian gay and bisexual men in Australia

“…A significant challenge in HIV prevention among overseas-born Asian GBMSM is the initial connection to sexual health services; after they become connected to these services, previous research suggests testing frequency and PrEP use are comparable to GBMSM born in Australia. 5,52 Our results support this, as those who had engaged in recent HIV testing had significantly lower odds of reporting CLAI without PrEP or UVL. Of the participants who engaged in CLAI without PrEP or UVL, 56.0% reported testing for HIV in the last year compared to 84.0% of those who did not engage in CLAI without PrEP or UVL.…”

HIV testing among immigrant men who have sex with men in Brazil

“…Understanding the factors influencing immigrants' decisions to undergo HIV testing is a complex issue that extends beyond Brazil and is influenced by various factors related to migration (e.g., access to healthcare, stigma, language barriers, and migration-related stressors), personal factors (e.g., fear, limited knowledge, internalized homophobia, and cultural beliefs), and specific aspects of sexual practices (e.g., types of partnerships established, prevention measures adopted) (Liu et al, 2018;Zhang et al, 2022). Given that these challenges have been primarily due to barriers such as language differences, lack of information about their rights, and unfamiliarity with the Brazilian healthcare system (Fauk et al, 2022).…”

Sexual health challenges in migrant, immigrant, and displaced populations 2022–2023

“…eHealth/mHealth interventions were particularly successful at targeting gay men and other MSM populations, using existing acceptability of online community outreach to boost PrEP uptake and HIV testing services [48]. Out of all available HIV prevention and testing methods, HIV self-testing and PrEP were preferred prevention tools among newly arrived gay men and other MSM in Australia, largely due to online access [49,71]. Screening availability at multiple service types appears to facilitate access.…”