New HIV testing technologies in the context of a concentrated epidemic and evolving HIV prevention: qualitative research on HIV self‐testing among men who have sex with men and transgender women in Yangon, Myanmar

Abstract

Introduction: Global effort to increase early diagnosis and engagement in HIV care emphasize the importance of developing novel approaches to reaching those missed by traditional methods. Such needs are particularly great for men who have sex with men (MSM), transgender women (TW), and other populations who face stigma. Myanmar’s HIV epidemic is concentrated among key populations and the revised National Strategy aims to reduce late diagnosis and barriers to care to curb HIV incidence among these groups. HIV self-testing (HIVST) may be one method to improve testing and diagnosis among key populations, by placing HIV testing and disclosure within the individual’s control.Methods: Formative, qualitative research including in-depth interviews with adult MSM (N = 12) and TW (N = 13) and focus group discussions with MSM, TW, and community key informants (N = 35) were conducted in June-September 2015 in Yangon, Myanmar. To inform a subsequent HIV care continuum intervention, including HIVST, participants’ opinions and perceptions about HIVST were elicited.Results: The confidentiality and privacy of HIVST, particularly as it related to disclosure of HIV status and sexual behaviour, was widely recognized among participants. These major advantages were further supported by the opportunity to avoid stigma, convenience of self-testing (reduced need for transportation and time to go to clinics), and the availability of a pain-free testing option. Participants weighed these benefits against perceived disadvantages of HIVST, the majority of which centred on the perception that HIVST does not include counselling. Participants were concerned that potential lack of counselling would result in poor mental health outcomes, inadequate linkage to HIV care and surveillance, and reductions in disclosure of HIV status. Participants did not view these disadvantages as an impediment, but provided suggestions for future implementation of HIVST in Myanmar.Conclusions: MSM and TW are optimistic about the confidentiality and privacy afforded by HIVST but wanted HIV counselling and linkage to appropriate services. The domestic reprioritization of HIV and opening of the country to international support has substantially increased the availability of HIV treatment and provides new opportunities, like HIVST, to potentially improve the HIV response for key populations who are at risk for HIV acquisition.

Is the Philippines ready for HIV self-testing?

“…HIVST provides individuals with an accurate, convenient test that can assure privacy and confidentiality, overcoming traditional barriers to facility-based testing among key populations [12,16,17]. Available studies from Asia, have shown HIVST to be acceptable among MSM and TGW [18][19][20][21].…”

Pilot Results from the First HIV/AIDS Intervention Among Transgender Women in the Middle East: Gender Affirmation and Social Support from Within Trans Communities in Beirut, Lebanon

“…2 Global efforts to address the HIV epidemic emphasize improving access to HIV testing, particularly among key populations. 3 HIV testing barriers that trans women experience include stigma, discrimination, and marginalization. 4,5 Members of this population in Lebanon experience these barriers due in part to rigid expectations of binary gender expression, 6 which can hinder HIV testing, early detection, and linkage to care.…”

Acceptability of HIV self-testing is low among MSM who have not tested: a study with respondent-driven sampling in Brazil

“…The HIVST has been put forward as a strategy to extend HIV diagnoses that may contribute to the reduction of transmission by enabling early diagnosis, access to care and treatment, and reduced viral load [20,39,40]. Our results suggest that the acceptability of HIVST is higher precisely among those who have already tested for HIV, and thus justify ample promotion of HIVST, particularly to MSM who are not used to routine testing.…”