HIV and STI Testing Preferences for Men Who Have Sex with Men in High-Income Countries: A Scoping Review

Abstract

Background: Regular testing for HIV and other sexually transmitted infections (STI) is recommended at least annually for sexually active men who have sex with men (MSM) in most high-income countries. To encourage regular use of HIV and STI testing and treatment services for MSM, we reviewed the literature to summarise the attributes of an HIV/STI testing service that MSM prefer. Method: We conducted a scoping review, searching PubMed, EMBASE, PsycINFO and CINAHL in January 2020 for articles reporting primary data on the preferences of MSM (living in high-income countries) for HIV/STI testing services. Two reviewers independently screened titles and abstracts and any discrepancies were resolved by a third reviewer. We extracted data on the service attributes that MSM preferred and summarised these thematically using a socioecological framework. Results: In total, 1464 publications were identified, 220 full texts were read and 57 were included in the final analysis. We found 21 articles addressing ‘individual’ attributes, 50 articles addressing ‘service’ attributes and 17 articles addressing ‘societal’ attributes. The key themes of preferences for HIV/STI testing services were: (1) the appeal of self-testing due to convenience and privacy; (2) the need to provide a variety of testing options; and (3) the influence of the testing experience, including confidentiality and privacy, tester characteristics and stigma. There were distinct patterns of preferences for subpopulations of MSM across studies, such as the preference of self-testing for young MSM, and of in-clinic testing for those who perceived themselves as high risk (i.e., with symptoms of STIs or exposed to a partner living with HIV). Conclusion: To make HIV/STI testing more accessible for MSM and encourage regular screening, it is important to address ‘individual’, ‘service’ and ‘societal’ attributes, such as enhancing the convenience of testing through self-testing, and providing a service that men feel comfortable and safe accessing. Furthermore, services should accommodate the preferences of diverse sub-populations within the MSM community.

Lessons Learned From the Implementation of a Pilot Study on Self-collected Specimen Return by Sexual Minority Men (Project Caboodle!): Qualitative Exploration

“…This afforded privacy and prevented an inadvertent disclosure of their involvement in sexual health research to the mail carrier or to someone they lived with such as a roommate or parent. Given the stigma associated with HIV and bacterial STI testing [ 58 , 59 ], as well as PrEP use [ 60 , 61 ] among GBMSM, the use of discreet packaging reduces the potential for discomfort or harm if the contents of the package are revealed to someone other than the participant. For extra discretion, neither our primary package (ie, the specimen self-collection box containing instructions and materials) nor our secondary package (ie, the cardboard United Parcel Service box used for shipping the specimen self-collection box) made any reference to the nature of the contents.…”

Perceptions and Experiences of Returning Self-collected Specimens for HIV, Bacterial STI and Potential PrEP Adherence Testing among Sexual Minority Men in the United States

“…Focusing first on the specimen self-collection box itself, our participants appreciated receiving it in plain unmarked packaging with no reference to the nature of its contents or to the study. Because of the stigma associated with HIV and STI testing and PrEP use, especially among GBMSM [ 57 – 59 ], shipping kits in discreet packaging is generally considered best practice [ 60 , 61 ]. Another practical aspect to consider is the choice of shipping carriers (e.g., Amazon, DHL, FedEx, UPS, US Postal Service) because not all of them deliver to rural areas.…”

“…Focusing first on the specimen self-collection box itself, our participants appreciated receiving it in plain unmarked packaging with no reference to the nature of its contents or to the study. Because of the stigma associated with HIV and STI testing and PrEP use, especially among GBMSM [57][58][59], shipping kits in discreet packaging is generally considered best practice [60,61]. Another practical aspect to consider is the choice of shipping carriers (e.g., Amazon, DHL, FedEx, UPS, US Postal Service) because not all of Frequently discussed facilitators of returning self-collected specimens as part of our study included an opportunity to confirm one's HIV, gonorrhea and chlamydia status, having limited access to a healthcare provider and a desire to advance research focusing on home-based testing, especially if it could serve sexual and gender minorities or rural communities.…”

Regular Testing of HIV and Sexually Transmitted Infections With Self-Collected Samples From Multiple Anatomic Sites to Monitor Sexual Health in Men Who Have Sex With Men: Longitudinal Study

“…Barriers such as cost, inconvenience, previous negative testing results, unawareness, confidentiality concerns, and lack of time might hinder uptake of HIV and STI tests, especially with regards to regular testing [ 12 ]. Apart from cost, the required sampling method for testing is an important factor affecting engagement in retesting [ 12 ]. Unlike urine, which is easily self-sampled, collection of pharyngeal and rectal swabs is commonly performed by health care workers in clinical settings.…”

“…Unlike urine, which is easily self-sampled, collection of pharyngeal and rectal swabs is commonly performed by health care workers in clinical settings. Self-sampled testing for HIV, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG) are preferred by some MSM as it overcomes the barriers of privacy concerns, time, and geographic limitations of services provided [ 12 ]. The cost of self-sampled testing for MSM could be lower by eliminating clinic attendance if the delivery cost is nominal.…”