Self-testing has the potential to boost HIV diagnosis rates among high-risk and hard-to-reach men who have sex with men (MSM) in China, according to a study published in the online edition of the Journal of Acquired Immune Deficiency Syndromes. A web survey showed that a fifth of men had self-tested for HIV and that self-testing was associated with being married, having high numbers of recent anal sex partners and recent HIV testing.
“HIV self-testing can effectively reach high-risk MSM and facilitate higher frequency testing,” comment the authors. “Self testing has the potential to increase knowledge of HIV serostatus and engage key populations in HIV prevention, treatment and care.”
Individuals can only benefit from HIV treatment and care if they are aware of their infection status. It’s therefore of concern that globally an estimated 20 million people are unaware they are living with the virus.
Obstacles to HIV testing can include convenience, concerns about confidentiality and privacy and also the stigma associated with screening for HIV. Self-testing, when an individual collects his or her own oral fluid of pin-prick blood sample and conducts a rapid HIV test, could increase rates of testing.
Self-testing may be useful in China and the sale of self-testing kits is not restricted by the country’s health authorities.
HIV prevalence among gay and other MSM in China is approximately 5%. Little is known about self-testing in this key population. An international team of investigators therefore designed an internet-based survey to determine prevalence of self-testing in this population and the factors associated with self-testing.
“Establishing appropriate HIV testing interventions in the Chinese context may have far-reaching consequences because there are a substantial portion of Chinese MSM who have never received HIV testing,” explain the investigators.
The study protocol was developed in collaboration with MSM and key stakeholders.
Men were eligible to participate in the study if they were aged 16 and older and had a lifetime history of anal sex with another man.
The online survey was implemented in May 2013 using the largest MSM web portals in Guangdong and Chongqing.
A total of 1342 men completed the survey. They were predominately young (55% were aged 20 to 30 years) and well-educated (53% had a college degree of higher). Approximately three-quarters identified as gay and 6% were living with HIV.
Overall, 60% reported having had an HIV test and 20% said they had self-tested for HIV.
Factors independently associated with self-testing were being married (aOR = 1.60; 95% CI, 1.08-2.36), having six or more recent anal sex partners (aOR = 4.25; 95% CI, 2.05-8.79), testing for HIV within the last twelve months (aOR = 2.16; 95% CI, 1.31-3.55) and having an annual income of at least US$16,000 (aOR = 1.76; 95% CI, 1.02-3.04).
The majority (71%) of those reporting self-testing reported paying less than US$16 for their testing kit. These kits were acquired through a variety of sources, including the internet (35%), community-based organisations (28%), pharmacies (18%), friends (10%) and sexual partners (7%).
The authors acknowledge their findings are based on a predominately young and well-educated convenience sample. Nevertheless, they conclude: “Our study suggests that HIV self-testing may be able to reach sub-groups of high-risk MSM and may enable more frequent HIV testing.”
Han L et al. HIV self-testing among online MSM in China: implications for expanding HIV testing among key populations. J Acquir Immune Defic Syndr. Online edition, DOI: 10.1097/QAI.0000000000000278 (2014).