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Home HIV self-test? Before Transa?

Is the use of HIV self-tests with sexual partners an appropriate strategy that should be encouraged by health agencies? Could you help people who are already irregular condom users to avoid unprotected sex with people with a different HIV status? Can it allow people with undiagnosed HIV to be tested?

As there are also questions about whether people would be able to handle the situation if the outcome appeared to be HIV positive – and concerns about the potential for partners to become angry or violent – ​​Professor Alex Carballo-Diéguez and colleagues conducted a randomized study in New York and Puerto Rico, whose results have just been published in a series of articles on AIDS and Behavior.

The project was called 'I'll show you mine' and explicitly encouraged participants to use OraQuick self-test kits to test themselves and their sexual partners.

Wide Diversity in Self-Test Study

To be eligible, participants had to be a man who has sex with men or a trans woman who was HIV negative, reported multiple recent sexual partners, did not consistently use condoms, and did not use PrEP. The 272 participants were ethnically diverse (including 57% Latino and 40% Black), mostly in their twenties and thirties, included 10% trans women, and did not identify themselves as homosexual (only 78% did).

Half of the participants were randomized to an intervention group that received ten OraQuick self-test kits, with the option to order additional kits if they needed more. They also watched a video that reflected other people's experiences and suggestions about using the test, addressing issues such as how to propose testing to a partner, the need to respect a partner's decision not to be tested, and possible partner reactions. They were instructed to exercise their best judgment when deciding which partners to ask for testing. Participants randomized to the control group did not receive the self-test kits or watch the video.

For three months, data on HIV testing and sexual behavior were collected regularly via text messages, with a follow-up visit at the end of this period.

How Tests Were Used

Of the 136 people who received the self-test kits:

  • One hundred tested themselves (although all had just tested HIV negative as part of the study procedures).
  • Seventy-one proposed using the test with at least one potential partner while communicating on a dating app or phone.
  • One hundred and eleven proposed using the test with at least one potential partner when they were together, with requests made to a total of 870 potential partners.

Tests were not used ​​with all partners - 79 participants said that in certain cases they did not request the test because they most often did not have the test kit with them or because they thought the partner was HIV negative, as well as feeling embarrassed about asking for the test, as well as thinking that it could ruin the atmosphere of the meeting, or simply because they are not planning to practice anal sex.

Forty-one people had at least one person refusing the test, however, this did not stop sex from taking place.

HIV testing. How is it done?

In fact, 18 participants started having sex without a condom.

The primary endpoint of the study was the number of times participants had condomless anal sex with a partner whose HIV status was unknown or positive in the previous three months.

The average number was 21 in the intervention group and 31 in the control group, suggesting that the intervention may have helped participants to avoid some risky situations. However, the difference was not statistically significant (rate ratio 0,68, 95% CI 0,45-1,05).

Not all potential partners responded well to the test suggestion.

There was violence

Of the 870 partners, 113 got angry or upset, including 16, who became physically violent.

These incidents—none of which resulted in serious injury—usually occurred at the time of test suggestion rather than after reading the results.

In the follow-up assessment, participants who received self-tests were asked about being able to deal with these situations. Twenty-two percent said that in certain circumstances it was very difficult to judge whether a partner could become violent, 7% said it was difficult to avoid violent situations and 6% said that in some cases it was very difficult to deal with a violent situation.

"Researchers hope that using self-test with partners has decreased the intrinsic risk of relying on intuition or what a partner says about their HIV status."

The authors do not believe that these “very limited” violent reactions undermine the case for testing sexual partners.

Aging with HIV

One potential harm that the studies lack data about is the people who use false negatives false negatives to guide the decision to have sex without a condom. As researchers set out to recruit people from communities with a high incidence of HIV, it is likely that some people have recently acquired HIV. OraQuick is a second generation test with a period de window oscillating between one and two months; therefore, people exposed to HIV during this period may not get an accurate result.

But given the sexual behavior of the participants, it is also likely that a proportion would have had sex without a condom anyway. Researchers hope that using self-tests with partners will lower the risk of relying on intuition or what a partner says about their HIV status.

Treatment of positive results

Fourteen of the participants had a partner who received a HIV positive preliminary reagent as a result of the test. They were equally likely to be new partners or fuck buddies (neither was a lover or primary partner). These tests usually took place at the participant's or their partner's home, with three taking place in a hotel or car.

On a scale of 1 (not at all stressful) to 10 (extremely stressful), participants gave these incidents an average rating of 6,4.

Asked about the confirmatory test, study participants said they thought that 12 partners had been tested and three had not, with the result unknown to the others.

Detailed interviews with ten of these participants whose partner received a reactive result showed that most were able to handle the situation. Partners who were surprised by the results were often distressed and sad or nervous, as these participants explained:

“He was tearful, frustrated, but not violent. I didn't want to continue spending time with me. He just walked away or just told me I'd better take him home.

Is the Test reliable?

Some partners questioned the validity and reliability of the test. Two were angry, but none were violent.

“When she finally accepted and came back positive, I was like, 'Oh! You are HIV positive. You need to go to the doctor or get a checkup or something. [She was] Like, 'Who the hell are you?' 'Who are you working for?' thinking I'm from the health department or some kind of informant.

For some other partners, the result confirmed their own intuition that they were living with HIV.

Some others had already been diagnosed, but the self-test made it easier to inform the study participant of their HIV status.

While some of the participants were supportive, others thought they should have been informed earlier, for example, by an ongoing partner.

Is the 60-day HIV immune window reliable?

Support Attempt

In general, participants were supportive and tried to be helpful when their partners got a reactive result:

“I told him 'look, let's retake the test so you can stay calm.' He retakes the test and exits the same way. But before taking the second test, I had already given him a list of phone contacts, in case another one came out positive. I asked him if I could contact him to find out his situation, to see how he was doing. He said yes, but he never answered my calls. I was really sad about that because he was such a nice person. ”

For many respondents, the reactive result served to interrupt the sexual encounter. In other cases, usually between sex partners, sex is resumed later, or there is an intimacy of a different nature:

“We hug more than we have sex. I mean, yes, there was penetration. But “light”, but – it was with a condom and lubricant. However, most of the time we are in caresses.”

Carballo - Diéguez and colleagues believe their findings support the feasibility of the intervention:

“Our findings demonstrate that [participants] can be motivated to use self-test with partners, convince their partners to use self-test, find very limited violent reactions, and identify previously undetected infected individuals. In these cases, individuals are able to satisfactorily deal with the positive results of the partner's self-test. ”

Translated by Cláudio Souza, on 07/07/2021 from the original written by Roger Pebody, on February 28, 2020 at Aidsmap

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Carballo - Diéguez A et al. Use of rapid HIV self-test to screen potential sexual partners: results from the ISUM study. AIDS and Behavior, online before printing, December 2019.

doi: 10.1007 / s10461-019-02763-7

Carballo - Diéguez et al. Few aggressive or violent incidents are associated with the use of HIV self-tests to screen sexual partners among key populations. AIDS and Behavior, online before print, February 2020.

doi: 10.1007 / s10461-020-02809-1

Balán IC et al. We then analyzed their results: New York City and Puerto Rico men who have sex with men report their sexual partners' reactions to receiving reactive HIV self-test results. AIDS and Behavior, online before print, February 2020.

doi: 10.1007 / s10461-020-02816-2



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