High levels of HIV testing in men who have sex with men (MSM) remain key to reducing HIV incidence. Current levels of testing remain sub-optimal; particularly the more frequent testing recommendations for men at higher risk of HIV through recent condomless anal intercourse (CAI). We report frequency of previous HIV testing at baseline in MSM who opted to enroll in a HIV self-testing (HIVST) RCT (SELPHI).
SELPHI is an internet based, open-label, randomised controlled trial, which aims to assess effectiveness of free HIVST kits on HIV diagnosis rates. Criteria for enrolment were aged ≥16 years old, male (including trans man) or trans women, ever had anal intercourse (AI) with a man, not known to be HIV positive and provided consent to link to national HIV surveillance databases. Participants were randomly allocated 3:2 at enrolment to a free HIVST versus no free HIV self-test. Data collected via an online survey included socio-demographics (gender, sexual identity, education, age, ethnicity, UK birth), sexual behaviour, HIV/STI testing history and PrEP and PEP use.
10,224 men were randomised; median age 33 years (IQR 26-44); 89% white; 20% born outside UK; <1% trans men; 47% degree educated; 8% ever used PrEP; 4% currently using PrEP. In the previous 3 months, 89% reported AI and 72% reported CAI with ≥1 male partner. Overall, 17%, 33%, 54%, and 72% had tested for HIV in the last 3 months, 6 months, 12 months, and 2 years respectively; 13% had tested more than 2 years ago and 15% had never tested. An association was observed between number of recent CAI partners and time since last HIV test (Figure 1). Among 3,972 men reporting ≥2 recent CAI partners, only 22% had tested in last 3 months and only 41% in last 6 months. In multivariate logistic regression analysis of selected sociodemographic factors, higher education level, being born outside UK and age between 20-40 years were independently associated with a higher likelihood of a recent HIV test. Only 9/388 men currently using PrEP had never tested for HIV.
MSM in SELPHI were not testing in line with current UK recommendations. Other SELPHI data suggest this is due to low perceived risk of HIV infection; structural barriers impacting testing opportunities (clinics difficult to access because of time constraints or capacity issues) and individual psycho-social issues including perceived stigma. Online promotion of free HIVST may be key to addressing many of these barriers.