Will MSM use over-the-counter rapid HIV tests to screen sexual partners?

If men who have sex with men (MSM) have the option of using rapid HIV testing to screen potential sexual partners, will they do so?

Until recently this was a hypothetical question. But in early July, the US Food and Drug Administration approved the first-ever rapid HIV test kit to be sold over-the-counter for home use. The test will become available to consumers in October.

When the rapid home HIV test was still undergoing regulatory review, researchers set out to learn whether non-monogamous HIV-negative MSM in New York would want to test sexual partners as a harm-reduction strategy. They specifically looked at testing-related behaviour in a cohort of 27 men who reported never or rarely using condoms.

The study findings were received with great interest at a session of the 19^th International AIDS Conference (AIDS 2012) in Washington DC.

Study presenter Alex Carballo-Diéguez explained that each study participant received 16 rapid HIV home-testing kits for optional use with sex partners over a three-month period. At the end of that time, the men were interviewed about their use or non-use of the kits.

Study participants collectively reported having a total of approximately 150 partners. They used rapid HIV home-testing kits with 101 partners. Another 23 partners were asked to undergo testing but refused. “Partner resistance to taking the test was seen as a sign not to have unprotected anal intercourse,” Carballo-Diéguez said.

Nine partners reportedly tested HIV-positive, five of whom were previously unaware of their HIV status.

According to participants’ accounts, sexual intercourse did not take place after HIV-positive test results were obtained. Another notable finding was that participants reported very few problems associated with use of the kits.

One of the study team’s concerns was whether rapid HIV home testing might trigger violence. Carballo-Diéguez reported that there were episodes of “aggressiveness” on "only" seven of the 124 occasions when kits were used. “It was someone who got upset, who stomped on the test, who cursed, but it was not really violence,” he said.

The researchers concluded that the rapid home HIV test is highly acceptable among high-risk MSM, and that it may also encourage beneficial modifications in risk behavior.

Carballo-Diéguez’s presentation generated a range of questions and comments from audience members. Two people called attention to the implications of the 'window period' for MSM using rapid HIV home testing to screen potential partners before having unprotected sex. Like most HIV tests, the rapid HIV home test cannot detect infection in someone who acquired the virus very recently. Thus, there is the question of whether an HIV-negative result on a home test might encourage unprotected sex in situations where one of the partners is highly infectious.

Extremely high HIV prevalence rates in some high-risk populations may override concern about the test failing to diagnose newly infected people, Carballo-Diéguez suggested. “When [there is] 30 percent HIV prevalence … we are still giving people a highly efficient tool to screen out everybody else who is HIV-positive.

“When I talk about the potential of home testing, I understand that there is a risk for some people,” he said. “But also, it’s an opportunity to empower people – it’s an opportunity for people to take prevention into their own hands.”

One audience member commented, “I remember a time when condom use was proposed as a method to have sex among MSM without needing to know who is infected or not – is that time over?”

Carballo-Diéguez responded by proposing that community members are ahead of HIV prevention workers “concerning what they are willing to do, and the risks they are willing to take”. He evoked laughter when he added, “I think that we unfortunately have a very paternalistic approach to them, treating them like fainting violets. These men who have sex with men are not fainting violets.”

Rachel Jones, a researcher addressing HIV risk reduction among very high-risk urban American women, noted the difficulty of translating study findings from MSM populations into insights that are relevant for women.

“Women are powerful. I'm not saying women are victims waiting to be victimised when you pull out a test,” she said. “But we need to figure out how … women can exercise this tool as well.”

Carballo-Diéguez agreed, saying, “I think gender issues are crucial here. There are power imbalances that need to be taken into account [whether] the woman or the man is going to [propose that a heterosexual partner take a rapid HIV home test]… This is an area that requires a lot of research.”