Preparedness for use of the rapid result HIV self-test by gay men and other men who have sex with men (MSM): a mixed methods exploratory study among MSM and those involved in HIV prevention and care.

OBJECTIVES: The aim of the study was to explore preparedness for the HIV self-test among men who have sex with men (MSM) and those involved in HIV prevention and care. METHODS: A mixed methods exploratory research design was employed, detailing awareness and willingness to use the self-test and the perceived barriers and facilitators to implementation. Quantitative and qualitative data collection and analysis were completed in parallel. Descriptive and inferential analysis of cross-sectional bar-based survey data collected from MSM through a self-completed questionnaire and oral fluid specimen collection (n = 999) was combined with qualitative, thematic, analysis of data collected through 12 expert focus groups (n = 55) consisting of gay men, National Health Service (NHS) staff, community organizations, entrepreneurs and activists. Findings were subsequently combined and assessed for synergies. RESULTS: Among MSM, self-test awareness was moderate (55%). Greater awareness was associated with increased educational attainment [adjusted odds ratio 1.51; 95% confidence interval (CI) 1.00-2.30; P = 0.05] and previous history of sexually transmitted infection (STI) testing (adjusted odds ratio 1.63; 95% CI 1.11-2.39; P = 0.01). Willingness to use the test was high (89%) and associated with meeting sexual partners online (unadjusted odds ratio 1.96; 95% CI 1.31-2.94; P < 0.001). Experts highlighted the overall acceptability of self-testing; it was understood as convenient, discreet, accessible, and with a low burden to services. However, some ambivalence towards self-testing was reported; it could reduce opportunities to engage with wider services, wider health issues and the determinants of risk. CONCLUSIONS: Self-testing represents an opportunity to reduce barriers to HIV testing and enhance prevention and access to care. Levels of awareness are moderate but willingness to use is high. Self-testing may amplify health inequalities.

Frequency of HIV testing among gay and bisexual men in the UK: implications for HIV prevention.

OBJECTIVES: The aim of the study was to explore HIV testing frequency among UK men who have sex with men (MSM) in order to direct intervention development. METHODS: Cross-sectional surveys were completed by 2409 MSM in Edinburgh, Glasgow and London in 2011 and a Scotland-wide online survey was carried out in 2012/13. The frequency of HIV testing in the last 2 years was measured. RESULTS: Overall, 21.2% of respondents reported at least four HIV tests and 33.7% reported two or three tests in the last 2 years, so we estimate that 54.9% test annually. Men reporting at least four HIV tests were younger and less likely to be surveyed in London. They were more likely to report higher numbers of sexual and anal intercourse partners, but not "higher risk" unprotected anal intercourse (UAI) with at least two partners, casual partners and/or unknown/discordant status partners in the previous 12 months. Only 26.7% (238 of 893) of men reporting higher risk UAI reported at least four tests. Among all testers (n = 2009), 56.7% tested as part of a regular sexual health check and 35.5% tested following a risk event. Differences were observed between surveys, and those testing in response to a risk event were more likely to report higher risk UAI. CONCLUSIONS: Guidelines recommend that all MSM test annually and those at "higher risk" test more frequently, but our findings suggest neither recommendation is being met. Additional efforts are required to increase testing frequency and harness the opportunities provided by biomedical HIV prevention. Regional, demographic and behavioural differences and variations in the risk profiles of testers suggest that it is unlikely that a "one size fits all" approach to increasing the frequency of testing will be successful.

Cruising for sex: sexual risk behaviours and HIV testing of men who cruise, inside and outwith public sex environments (PSE).

This paper describes sexual risk behaviours and HIV testing amongst men who cruise an urban public sex environment (PSE) in southern England. Data were collated using a cross-sectional survey (response rate = 56%; n=216), sampling men from directly within the PSE. As such, this represents the first peer-review study generalizable to the wider population of urban PSE users. The current sample reflect a highly sexually active population, almost one-third (31%) reported over 50 sex partners in the last year. However, just one-quarter (26%) reported unprotected anal intercourse (UAI) with at least one partner outside of a 'safer sexual strategy'. Almost 1 in 12 (7%) reported UAI within the PSE. Over two-thirds (71%) had had a named HIV test of whom 16% had tested HIV positive. Just one-third (34%) of negative/untested PSE users had tested within the previous two years. Positive men were significantly more likely to report unsafe sex within the PSE in the last year. PSE users report lower levels of UAI than men in the local gay community but higher HIV prevalence. PSE-based UAI remains an HIV (re)infection risk. In concert, these findings suggest the importance of in situ targeted health promotion to prevent PSE-based risks.

Men who have sex with men (MSM) in public sex environments (Pses): a systematic review of quantitative literature.

We systematically review quantitative research relating to the sexual behaviours of MSM in PSEs. We examine the methodological rigour of these studies to determine an appropriate framework for future PSE-based research and quantify sexual behavioural trends therein. Medline, BIDS, Web of Science and recent HIV/AIDS conferences were searched according to a systematic inclusion criteria. Nine papers were included for review. Recruitment of participants' outwith PSE settings, and low response rates (6%) of participants contacted in situ, question the validity and generalizability of current evidence. Most PSE users were gay or bisexually identified and half of men in the gay community reported recent PSE use. Around 10% of men reported casual status-unknown/serodiscordant unprotected anal intercourse (UAI) within PSEs. HIV testing rates amongst PSE users were similar to the wider gay community, though the proportion of men who tested positive was twice as high. Rates of casual UAI suggest that PSEs represent important sites for HIV prevention. However, since extant evidence is scant and methodologically flawed, further research is urgent. Such work must recruit participants in situ, and obtain satisfactory response rates, to be generalizable to the wider population of men who cruise.

Gay men's HIV testing behaviour in Scotland.

This paper reports on the social and demographic factors associated with HIV testing in gay men in Scotland. Trained sessional research staff administered a short self-complete questionnaire to men in gay bars during January and February 1999 in Glasgow and Edinburgh, Scotland. Questionnaires were completed by 2,498 men (response rate of 77.5%). Half (1,190; 50%) reported ever having been HIV antibody tested, with men in Edinburgh more likely to report testing. Testing was associated with being older (26 years plus), higher education, reporting one unprotected anal intercourse (UAI) partner, or six or more UAI partners, in the last year, genitourinary medicine clinic service use, and lifetime experience of sexually transmitted infections. There was no relationship between HIV testing and treatment optimism, or evidence of a "post-Vancouver" effect. Over a fifth of men who said that they knew their own HIV status at last UAI had never been tested. Current testing policy needs to be challenged if there is to be an increase in the number of gay men who know their HIV status and, if tested HIV-positive, to then access antiretroviral treatments.

Does bar-based, peer-led sexual health promotion have a community-level effect amongst gay men in Scotland?

This paper evaluates the effectiveness of a bar-based, peer-led community-level intervention to promote sexual health amongst gay men. The intervention consisted of peer education within bars, gay specific genitourinary medicine (GUM) services and a free-phone hotline. Data were collected at baseline (1996) and at follow-up (1999) in gay bars in Glasgow (intervention city) and Edinburgh (control city). During the intervention peer educators interacted with 1484 men and new clients increased at the gay specific GUM service. However, the hotline was under-utilized and abused. The outcome measures were: reported hepatitis B vaccination; HIV testing; unprotected anal intercourse (UAI) with casual partners; negotiated safety; and amongst men reporting UAI with a regular partner, the proportion who knew their own and their partner's HIV status. Significant differences in sexual health behaviours were observed across locations and across time, but the only significant intervention effects were amongst men who had direct contact with the intervention, with higher uptake of hepatitis B vaccination and HIV testing. The intervention did not produce community-wide changes in sexual health behaviours. These results question the replication and transferability of peer-led, community-level sexual health promotion for gay men outwith the USA and across time.

The Gay Men's Task Force: the impact of peer education on the sexual health behaviour of homosexual men in Glasgow.

OBJECTIVE: To assess the impact of a peer education intervention, based in the "gay" bars of Glasgow, which sought to reduce sexual risk behaviours for HIV infection and increase use of a dedicated homosexual men's sexual health service, and in particular increase the uptake of hepatitis B vaccination. DESIGN: Self completed questionnaires administered to men who have sex with men (MSM) in Glasgow's gay bars. SUBJECTS: 1442 men completed questionnaires in January 1999, 7 months after the end of the 9 month sexual health intervention. MAIN OUTCOME MEASURES: Self reported contact with the peer education intervention, reported behaviour change, and reported sexual health service use. RESULTS: The Gay Men's Task Force (GMTF) symbol was recognised by 42% of the men surveyed. Among men who reported speaking with peer educators 49% reported thinking about their sexual behaviour and 26% reported changing their sexual behaviour. Logistic regressions demonstrated higher levels of HIV testing, hepatitis B vaccination, and use of sexual health services among men who reported contact with the intervention. These men were more likely to have used the homosexual specific sexual health service. Peer education dose effects were suggested, with the likelihood of HIV testing, hepatitis B vaccination, and use of sexual health services being greater among men who reported talking to peer educators more than once. CONCLUSION: The intervention had a direct impact on Glasgow's homosexual men and reached men of all ages and social classes. Higher levels of sexual health service use and uptake of specific services among men who had contact with the intervention are suggestive of an intervention effect. Peer education, as a form of health outreach, appears to be an effective intervention tool in terms of the uptake of sexual health services, but is less effective in achieving actual sexual behaviour change among homosexual men.

Sex and sexual orientation: the effect of group membership on individuals' judgments about self and others' HIV risk.

No previous study has directly compared homosexual and heterosexual men and women's perceptions of HIV risk. In fact, empirical research focusing on homosexual women's perception of HIV risk is scarce. This paper, therefore, examines whether homosexual and heterosexual women and men (N = 60) make varied self and other (peer and non-peer) HIV risk judgments. The paper also examines the roles of motivational (health anxiety) and cognitive (HIV knowledge) factors in relation to HIV risk judgments. The results show that each group held different perceptions of risk for various "other" groups. Only homosexual men showed evidence for an optimistic bias, whereas homosexual women showed evidence of realistic perceptions. Both cognitive and motivational factors were shown to be associated with risk judgments for homosexual women and heterosexual men. Methodologically the use of Multidimensional scaling as an analytic strategy is recommended.

A comparison of high-risk sexual behaviour and HIV testing amongst a bar-going sample of homosexual men in London and Edinburgh.

BACKGROUND: This study compared high-risk sexual and HIV testing behaviour amongst homosexual men recruited from gay bars in London and Edinburgh. METHODS: A cross-sectional survey monitoring high-risk sexual and HIV testing behaviour using a self-completed questionnaire was conducted in November and December 1996. RESULTS: Two thousand, three hundred and ninety-seven questionnaires were returned (1,366 recruited in London and 1,031 in Edinburgh), with a response rate of 77%. A larger proportion of men surveyed in London had had unprotected anal intercourse (UAI) with one or more male partners in the previous year (35%) than in Edinburgh (30%). Men recruited in Edinburgh were less likely to have had an HIV test (54%) than men in London (63%). In both surveys, 25% of men who reported UAI with partners of the same HIV status as themselves also reported never having had an HIV test. CONCLUSIONS: The observed dissimilarities in the HIV epidemic in the two cities may be accounted for by the differences in self-reported high-risk sexual and HIV testing behaviours between the two populations. A large proportion of men in both cities continue to engage in high-risk sexual behaviour suggesting continued transmission of HIV in these populations. Thus, there is a continued need for innovative and relevant health promotion amongst homosexual men in the UK.

Homosexual men's HIV related sexual risk behaviour in Scotland.

OBJECTIVE: To date, the epidemic of HIV infection in Scotland has been primarily associated with injecting drug use. However, the epidemiology of HIV in Scotland changed in the late 1980s, with homosexual men becoming the largest group at risk of HIV infection and AIDS. Our aim was to describe homosexual men's sexual risk behaviours for HIV infection in a sample of men in Scotland's two largest cities. DESIGN/SETTING: Trained sessional research staff administered a short self completed questionnaire, to homosexual men present in all of Glasgow's and Edinburgh's "gay bars," during a 1 month period. SUBJECTS: A total of 2276 homosexual men participated, with a response rate of 78.5%. Of these, 1245 were contacted in Glasgow and 1031 in Edinburgh. MAIN OUTCOME MEASURES: Sociodemographic data, recent (past year) sexual behaviour, information on last occasion of anal intercourse with and without condoms, and sexual health service use. RESULTS: Anal intercourse is a common behaviour; 75% of men have had anal intercourse in the past year. A third of our sample report anal intercourse with one partner in the past year, but 42% have had anal intercourse with multiple partners. Over two thirds of the total population have not had any unprotected anal intercourse (UAI) in the past year and a quarter of the sample have had UAI with one partner only. 8% report UAI with two or more partners. More men in Edinburgh (17% v 10%) reported unprotected sex with casual partners only, but more men in Glasgow (29% v 20%) reported UAI with both casual and regular partners (chi 2 = 12.183 p < 0.02). Multiple logistical regression found that odds of UAI are 30% lower for men with degree level education and 40% lower for men who claim to know their own HIV status, whereas they are 40% higher for those who have been tested for HIV and 48% higher for infrequent visitors to the "gay scene". Men who have had an STI in the past year are 2.4 times more likely to report UAI than those who have not. Men with a regular partner were significantly more likely to report UAI, as were those who had known their partner for longer, and who claimed to know their partner's antibody status. CONCLUSION: On the basis of current sexual risk taking, the epidemic of HIV among homosexual men in Scotland will continue in future years. The data reported here will prove useful both for surveillance of sexual risk taking, and the effectiveness of Scotland-wide and UK-wide HIV prevention efforts among homosexual men.