In many research studies, individuals who test positive for HIV infection are asked if they had a prior HIV diagnosis. We evaluated the reliability of self-report of HIV status among men who have sex with men (MSM) who were screened for participation in the HIV Prevention Trials Network (HPTN) 075 study. This study evaluated the feasibility of recruiting and retaining MSM in sub-Saharan Africa for HIV prevention trials.
The HPTN 075 study population included HIV-infected and HIV-uninfected MSM ages 18-44 years at four study sites (Kisumu, Kenya; Blantyre, Malawi; Soweto and Cape Town, South Africa). Men who were on antiretroviral therapy (ART) or in HIV care were not eligible for the study. Knowledge of HIV status at screening was assessed with self-report and retrospective antiretroviral (ARV) drug testing using an assay that detects 20 ARV drugs. Men were classified as previously diagnosed if they reported being HIV-infected or had ARV drugs detected that indicated that they were on ART. Logistic regression was used to compare characteristics of previously diagnosed men who did or did not report a prior HIV diagnosis.
We analyzed samples and data from 183 men who were HIV-infected at screening; 67 (36.6%) of the 183 men reported that they were HIV infected. Among the 116 men who did not report a prior HIV diagnosis, 36 (31.0%) had ARV drugs detected (30 reported a negative HIV status, one reported not knowing his status, and five reported no prior HIV test). After accounting for ARV drug use, 103 (56.3%) of the men were classified as previously diagnosed and 80 (43.7%) were classified as newly diagnosed. Among previously diagnosed men, the following groups were more likely to report a positive HIV status: men from Soweto, South Africa (compared to men from Kenya, p=0.006) and men who reported having sex with men only (compared to men who reported having sex with men and women, p=0.002).
In this cohort, ~30% of the HIV-infected men screened for the study who did not report that they were HIV-positive were on ART. HIV-infected men who reported having sex with men only were more likely to report knowledge of their HIV status. The accuracy of self-report for identifying individuals who are aware of their HIV-positive status has serious limitations. Understanding factors associated with disclosure of HIV status in different populations and settings may help inform HIV treatment and prevention studies.