Is using HIV self-tests with sexual partners an appropriate strategy that should be encouraged by health bodies? Could it help people who are already irregular condom users to avoid unprotected sex with people of a different HIV status? Might it enable people with undiagnosed HIV to get tested?
As there are also questions about whether people would be able to handle the situation should the result appear to be HIV positive – and concerns about the potential for partners to be angry or violent – Professor Alex Carballo Diéguez and colleagues at the HIV Centre for Clinical and Behavioural Studies, division of gender, sexuality and health, New York State Psychiatric Institute and Columbia University, ran a randomised study in New York City and Puerto Rico.
The project was called “I’ll show you mine” and explicitly encouraged participants to use OraQuick self-testing kits to test themselves and their sexual partners. For three months, data on HIV testing and sexual behaviour was collected regularly via text messages, with a follow-up visit at the end of this period.
Not all potential partners responded well to the suggestion of testing. Of the 870 partners, 113 became angry or upset, including 16 who became physically violent. These incidents – none of which resulted in serious injury – usually occurred at the time of suggesting the test, rather than after reading the results.
Carballo Diéguez and colleagues believe their findings support the feasibility of the intervention: “Our findings demonstrate that (participants) can be motivated to use self-testing with partners, succeed in convincing their partners to use self-testing, encounter very limited violent reactions, and identify previously undetected infected individuals. In such cases, individuals are able to deal with partners’ positive self-test results satisfactorily.”
Men who have sex with men and transgender women who had multiple sexual partners in the prior 3 months participated in ISUM, a randomized, controlled trial of self- and partner-testing in New York City and San Juan, PR. Only 2% of screened participants were ineligible to enrol due to anticipating they would find it very hard to avoid or handle violence. The intervention group received free rapid HIV self-test kits. During the trial, 114 (88%) of intervention participants who were assessed at follow-up used self-tests with at least one potential partner. Only 6% of participants who asked a partner in person to test reported that at least one of their partners got physically violent, some in the context of sex work. In total, 16 (2%) partners reacted violently. Post-trial, only one participant reported finding it very hard to handle violence, and none found it very hard to avoid potential violence.
Alex Carballo-Diéguez, Rebecca Giguere, Iván C Balán, Curtis Dolezal, William Brown III, Javier Lopez-Rios, Alan Sheinfil, Timothy Frasca, Christine Rael, Cody Lentz, Raynier Crespo, Catherine Cruz Torres, Cheng-Shiun Leu, Irma Febo
Secondary distribution of HIV self-tests to sexual partners is acceptable but concerns remain about reactions if a partner tests HIV-positive. We report on 14 participants whose sexual partners tested HIV-positive during the “I’ll Show You Mine” Study, a randomized controlled trial (N = 272) of HIV self- and partner-testing among men who have sex with men (MSM) and transgender women (TGW). All 14 were MSM and racial/ethnic minorities, mean age was 36.6 years; 86% were gay-identified. Twenty-four partners tested positive; about half were new partners. Six participants had multiple partners test positive. During in-depth interviews with 10 of these participants, they reported their partners’ reactions ranged from tearful and worried among those whose result was unexpected, to resignation among those who suspected a positive result, to nonchalance among partners who participants concluded knew of their HIV infection. After testing, some HIV-positive partners disclosed prior knowledge of their status. No partner reacted violently. Participants typically comforted their partners and encouraged confirmatory testing. Four participants had anal intercourse with partners who tested positive. Participants and partners were able to effectively handle situations in which the partner tested HIV-positive.
Iván C Balán, Javier Lopez-Rios, Rebecca Giguere, Cody Lentz, Curtis Dolezal, Catherine Cruz Torres, William Brown III, Raynier Crespo, Alan Sheinfil, Christine Tagliaferri Rael, Irma Febo, Alex Carballo-Diéguez