Men Prefer Self-Testing At Home

The overwhelming majority of South African men who have sex with men (MSM) prefer to privately self-test themselves for HIV, a new survey indicates. Nine out of ten MSM who were surveyed said they would rather go through an HIV test on their own than test for HIV at a clinic.

Do South African men avoid HIV testing at clinics simply out of fear of what others think? Researchers say “yes,” but they also value the self-empowerment of getting their own results.  “South African men who have sex with men (MSM) have a high burden of undiagnosed HIV infection and HIV-testing rates incommensurate with their risk,” researchers stated. “HIV self-testing (HIVST) may increase testing uptake, frequency, and earlier HIV detection and treatment.”

By providing more opportunities to test for HIV in private, the rate of incidence of HIV could be improved in South Africa and elsewhere. But first, researchers wanted to determine which methods of detection work best.

For the study, 127 participants, mostly male, were selected from two regions in northeast South Africa, Gert Sibande and Ehlanzeni, located in the Mpumalanga Province. Many of the participants who were selected participated in The Mpumalanga Men’s Study, a similar previous behavioral risks survey.

The study involved 54 men and one transgender woman from Gert Sibande and 72 men from Ehlanzeni. Although the majority of participants identified as bisexual, 80 percent of the participants from Gert Sibande and 86 percent of the participants from Ehlanzeni admitted that they have a regular male sex partner. A smaller number of participants reported having a regular female sexual partner.

All participants were given HIV self-testing kits and a follow-up meeting was arranged at the three-month period and at the six month period. Out of the pool of participants, 91.3 percent of the men self-tested at least once and nearly half self-tested twice.

The subjects were given both oral fluid and finger prick tests. The participants preferred the finger prick test (55 percent), simply because they trusted the results more than the oral fluid test.

By the time the study was over, six of the 127 study subjects tested positive for HIV. On a side note, the study authors noted a very high incidence of HIV transmission among the group — which is not surprising in any group of (mostly) sexually active MSM. They also were aware of at least 40 instances of new diagnoses among the study participants’ contacts. Participants distributed 728 tests to family and friends over the course of the study, and it surprised researchers how often men passed the tests along to family members. “[HIV self-testing] use and network distribution is acceptable and feasible for MSM in South Africa and can increase testing uptake and frequency,” researchers concluded, “potentially improving early detection among MSM and their networks.”

Participants were asked at the six month mark which method of HIV testing they prefer. Eighty-three percent said they preferred self-testing while only 11 percent said they prefer clinic testing.

Participants said that the reasons for choosing the self-testing kit was because of convenience, privacy, and that they found it more self-empowering. The small number of participants who preferred clinic testing said they preferred having support from on-site counselors.

Similar tests on HIV testings preferences have been conducted in the past in Australia and in the United States. Researchers also noted that while HIV tests only cost $6-12 USD, even at that price many low income South Africans cannot afford to test themselves.