Use of a Rapid HIV Home Test Prevents HIV Exposure in a High Risk Sample of Men Who Have Sex With Men

Alex Carballo-Diéguez; Timothy Frasca; Ivan Balan; Mobolaji Ibitoye; Curtis Dolezal

Disclosures

AIDS and Behavior. 2012;16(7):1753-1760. 

In This Article

Results

Sample Description and Baseline Behavior

Approximately one out of eight potential study volunteers who contacted us passed the pre-screening criteria. Forty-four men initially qualified and were invited to attend the in-person screening Visit 1. Of these, 12 did not qualify for enrollment due to the following reasons: three tested HIV-positive; three did not feel capable of handling violent situations; three did not report qualifying risk behavior despite their initial pre-screening profile; one participant reported that he would not ask a partner to use HT under any circumstances; and one was unable to understand the window period of the test despite clarification from the research assistant. In addition, two participants were excluded when they provided contradictory or false data. (One participant was disqualified for two of the above reasons).

Of the 32 participants enrolled in the study, four did not complete all study procedures and a fifth case was discarded due to unreliable data. The men who completed the study did not differ from the excluded men in terms of their expressed likelihood to use the test on themselves; although they were marginally less likely to use HT with partners (P = .051), their answers were nevertheless within the likely-to-use range.

The final sample consists of 27 men. Table 1 presents their sociodemographic characteristics.

Table 2 shows that participants had engaged in significant sexual risk behavior in the prior 3 months as evidenced by their multiple partners and frequency of unprotected receptive and/or insertive anal intercourse. Almost all participants reported consuming alcohol in the prior 3 months, slightly over half used marijuana, and more than one-third used other drugs. Almost half of the participants had had an STI in the course of their lives, the most frequent being gonorrhea. Fifteen percent of the sample reported having had three or more STIs in their lives. By study design, all participants were HIV-uninfected. Eighty-eight percent of them reported having been tested for HIV within the past 2 years.

Utilization of HT Kits

According to IVRS and in-depth interviews, the participants had approximately 140 sexual partners during the 3 months of study. They proposed using the kit to about 124 men of whom 101 accepted and 23 refused. Ten tested individuals got HIV-antibody positive results. Seven were potential sexual partners and three were acquaintances of the participants; six of the ten were unaware of their status. Two participants each tested two partners who got positive results.

Below, we present excerpts from in-depth interviews that characterize in the participants' words their experiences using HT. Each quote includes participant ID, age, and ethnic group in parentheses.

Participants liked having access to HT for use with partners and found it easy to use.

You just swipe it once on the top [gum], swipe it once on the bottom, and then put it in the test tube and stuff like that. It's pretty easy. Simple. (#1014, 25 years old, AA)

Although about one-fifth of the partners refused to use the test and left the place of the encounter, most partners were receptive to using HT prior to sex.

People were a lot more willing to try the test than I was expecting,… and I had no problems, no hostility or anything toward me asking them to take the test. And it went perfectly fine. (#1035, 19, L)

Lack of partner resistance to taking the test was seen as a good sign. When partners resisted, participants often interpreted it as a warning not to have sex with that person.

And the ones that wasn't with it, either I didn't do nothing with them, or I used a—or I used a condom with them. Yeah, 'cause I just didn't trust it 'cause I was thinking they was infected." (#1014, 25, AA)

Most participants used HT at home, but 17 of them reported carrying the kits and using them at their partners' homes or even in public places.

At this point, I start carrying some of them with me, the tests with me. So just in case anything happens, I have my little plastic baggie, open it up, do what we have to do. And we went to his place, and I said, you know, I really like you, this is really hot, and I think we can really have fun here. How would you like to test with me? (#1015, 33, W)
It was a little awkward to wait in the bathroom at the supermarket, waiting for the results. (#1035, 19, L)

Often, mutual testing took place.

I did it for him, and he did it for me. We opened the kits, you know, like put them side-by-side. And I swabbed him. He swabbed me. We put it in. And then we waited the 20 min, which seemed like a lifetime [laughs]. (#1017, 47, W)

Although waiting 20 min for the results provoked anxiety in four participants, the rest did not report such problems. They reported playing video games, watching TV, eating, drinking, "rolling weed," smoking, or engaging in foreplay; some found the wait beneficial to ponder what to do next.

The 20-min window sort of gives you that extra 20 min to decide, "Okay, if this comes back negative, am I really ready to bareback?" (#1017, 47, W)

Substance use was frequent in this sample (only three participants reported no substance use); yet, in most cases it did not appear to hamper HT use.

If you would just meet somebody in a bar, having a few drinks, some of the inhibitions come down, the walls come down, and other topics of conversation are available to come above to the surface. So I think with the alcohol with the testing, I think it was just the way that I can incorporate the tests into the conversation or between our engagement as not a tool, but just as a preface to go on to do other things. (#1016, 43, W)

Two prospective partners knew they were infected with HIV and disclosed it to the participant when he proposed to use HT. In one case the partner stated that as he was planning on using condoms and his viral load was undetectable, there had been no need to disclose his status before. Conversely, six out of seven partners with reactive tests were unaware of their positive status and found it out using HT.

So we're chatting at dinner, and it's definitely leaning in the sexual area […] And it built up into let's go to, you know, let's go to your place […]. Matter of fact, when we get there, since I'm already part of this study, you know, about basically HIV awareness, and risk, and risk taking, why don't I test in front of you, would you like to test with me? Cool, that would be great. Then we can have as much fun as we want. You know, and it went really, really well. And then he got the [positive] result [laughter]—He had no idea, I guess. […] He's like, What do you mean? I'm pretty sure it didn't give you a false positive, this is a, you know, this is pretty straightforward. Listen, I still like you, we can still fool around if you want to. You know, I don't know what you're going through at the moment. I know for me, when I found out about the Hep [Hepatitis C], I thought my world had come to an end. […] So if you want to hug, I'll give you a hug, like, I'm here for you. […] And he got pretty upset, you know, it was hard to see that. I said listen, I'll go with you, if you want to go to another clinic and get retested, if you want me to bring you down to, you know, one of the counseling centers, if you want to contact the people in my study, I can do that. He just said, you know, I'd really like to just kind of take some time alone. And I said, Are you going to be all right? You know, like, I worried he might do something crazy, you know, and I really didn't want to see that happen. So, I gave, you know, I left him with my number, I said, If you need to call me, please do. You know, please leave all the sexual stuff aside, like, you're another person, and I care, you know? We can always fool around later if you want to, but that doesn't change how I feel about you and what I think of you. So, you know, nothing really happened after the testing, but as far as I know, he said he was going to go get services. [Afterwards] I left him a message and texted him, but I don't want to be pushing it, obviously, because he's going through a lot. (#1015, 33, W)

There were very few adverse experiences. Out of the approximately 124 occasions in which participants invited their partners to use HT, seven led to verbally aggressive situations (two participants reported two aggressive situations each); none of them resulted in violence towards the participant. In one case the sexual partner became angry with the participant when he proposed to use HT unexpectedly during the sexual event. In another case a partner who tested positive stomped on the test kit and started cursing; he did not attack the participant. The participant described this partner as a rough, belligerent type who could react negatively but with whom he decided to go anyhow and propose HT use. One participant whose partner reacted aggressively said that he (participant) always carries a weapon when he goes to someone's home, thus indicating that he anticipates violence and gets involved in potentially violent situations. Of the four calls that were made to the hotline, all dealt with questions about interpretation of test results; none was due to a violent episode as a result of using HT.

No UAI occurred in any of the cases in which a participant found that a prospective partner was HIV-infected.

The people that I tested that actually came out positive, I didn't proceed to have sex with them. […] I still hung out or whatever like that, but I didn't wind up having sex though. It definitely put it in my mind that I shouldn't have sex with the person. (#1030, 26, L)

Participants were three times more likely to report that using HT made them reduce their risk, be more cautious, practice safer sex, or think more about whom to have sex with than they were to report that use of HT made them more likely to have UAI.

Because I've been in the study […] I'm kind of ruined from having sex with people where I don't know what their status is. But I'll tell you this, I always ask now. That's the closest I can come to knowing, and I want as much of that kind of feeling as I can get. And it always makes me wish I had the test to see if I was right. (#1021, 58, AA)

Participants felt they could trust the test, and although they thought the test was not for everyone, they hoped it would soon be available OTC

I wish there were tests for everything, for syphilis, for gonorrhea, for meningitis, for tuberculosis. That happened to me one time where somebody—oh, what a mistake. I met somebody in a bathhouse […] in St. Louis and bought him a ticket to come out and see me. And he never came. I got a phone call from his friend who said he died, passed away, that he had tuberculosis and AIDS, and he didn't tell me either of these things. That's why it's good. Had that been the case that I would have mentioned to him on the phone, you know, do want to visit me in New York City? By the way, I have this test kit. Would you be willing to take this test? Then maybe he'd 'fess up and say, Well, I better tell you the truth. I am positive. And then I would, Thank you very much. See you later. So I think this will definitely save lives, definitely. (#1020, 56, W)

processing....