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Gay men’s social media helps find HIV cases

DIY sampling also picked up cases at early stage when easier and cheaper to treat

Louise Prime

Wednesday, 25 May 2016

Offering do-it-yourself sampling kits for human immunodeficiency virus (HIV) through gay men’s online social media can help pick up previously undiagnosed cases, and often at an early stage when the infection is potentially easier and cheaper to treat, according to a study* published today in Sexually Transmitted Infections.

Public health doctors are concerned that stigma, inconvenience, lack of time, lack of guaranteed anonymity and unwanted counselling may all deter men who have sex with men (MSM) from seeking an HIV test. Public Health England has estimated (in 2013) that about one in eight MSM in London has HIV infection, of whom 16% don’t realise that they are infected; furthermore, a third of those diagnosed are already at a late stage, making disease more difficult and expensive to control.

To try to tackle this problem, the Dean Street sexual health clinic in London in 2011 launched a DIY home sampling kit for MSM, which men could access through social media they might use to find sexual partners – Gaydar, Grindr, Recon and gay magazines’ Facebook pages. First, men were asked questions about their condom use, timing of last unprotected sex, if and when they had last been tested for HIV, and their partners’ HIV status. They could then request a home sampling kit whatever their level of risk. This would be sent within 24 hours, with instructions (for taking a mouth swab or, from August 2013, a finger prick blood sample), a prepaid return envelope and advice on safe sex and reducing their risk of infection.

A research team from the Chelsea and Westminster Hospital in London have now analysed the effectiveness of the project, for the two-year period from January 2012 to December 2013. Of the 17,361 men who completed an initial risk assessment during this time, nearly half (45%) had been at risk of HIV infection and more than a third (36%) had never been tested for it. Of the 11,127 who then clicked for further information, almost a third (30%) had never been tested, and 41% had – since their last HIV test – had unprotected sex with someone whose HIV status they didn’t know. Most (10,323) of the men who asked for further information then requested a sampling kit, and 5,696 returned them.

Of the returned kits, 122 were ‘reactive’; 82 were confirmed HIV positive, i.e. 1.4% of all returned samples (≥0.2% is considered cost effective). These men all received further care. There were also 14 false reactives (which the researchers said was higher than expected, and warrants further evaluation) and 14 already diagnosed HIV.

One in five (20%) of the newly diagnosed men had a test result consistent with very recent infection, i.e. within the past few months.

The study authors commented that this service removed many of the perceived barriers to getting tested for HIV, and potentially diagnosed people before disease progression to costly advanced HIV infection. They said: “Whilst there remains an ongoing debate around home sampling’s lack of immediate linkage into care or opportunity to test for other sexually transmitted infections, it is important to note that, through eliminating key barriers to testing, we have the potential to reach MSM who may not otherwise test for HIV, while still offering online education and engagement with services, which home testing may not provide.”

* Elliot E, Rossi M, McCormack S, McOwan A. Identifying undiagnosed HIV in men who sex with men (MSM) by offering HIV home sampling via online gay social media: a service evaluation. Sex Transm Infect 2016; 0: 1–4. doi:10.1136/sextrans-2015-052090.

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