Department of Public Health, Environment and Society, London School of Hygiene and Tropical Medicine, 5-17 Tavistock Place, London, WC1H 9SH, UK.
Institute for Global Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK.
BMC Public Health. 2022 Apr 22;22(1):809. doi: 10.1186/s12889-022-13189-7.
HIV self-testing (HIVST) could play an important role in improving access to testing and therefore reducing inequalities related to late diagnosis of HIV, while also improving access to HIV prevention interventions such as HIV pre-exposure prophylaxis. This study sought to understand the potential role of HIVST by exploring the experiences of Asian, Black and Latin American men who have sex with men (MSM) accessing the gay scene and the circulation of HIV testing norms; experiences of accessing HIV testing services; HIVST acceptability and preferences for intervention adaptations.
Twenty-nine qualitative interviews were conducted with Asian, Black and Latin American MSM who had participated in SELPHI, an HIVST randomised controlled trial. Topics included HIV testing history, HIV testing patterns, experiences of accessing sexual health services, mental health, engagement with HIVST and SELPHI, and experiences of the gay scene. Interviews were audio recorded, transcribed and then analysed using a thematic framework.
The gay scene was identified as an important site for learning about HIV and being exposed to norms reinforcing the importance of protective behaviours. However, experiences of discomfort due to perceptions of 'whiteness' on the scene or experiences of racism may hinder the protective function the scene could play in developing norms influencing HIV testing behaviour. Discomfort in clinic waiting rooms was identified as a substantial barrier to accessing clinical services and many interviewees expressed preferences regarding the personal characteristics of healthcare providers. HIVST was found to be acceptable and some interviewees suggested potential adaptations of the HIVST offer, such as packaging HIVST with at home sexually transmitted infections testing options.
HIVST responds to some service access barriers experienced by Asian, Black and Latin American MSM. The decoupling of HIV testing and clinic attendance may be particularly valuable for MSM of minority ethnic backgrounds who are likely to experience anxiety and discomfort in clinic waiting rooms more acutely than White MSM due to concerns around implied disclosure. This suggests that HIVST may have the potential to increase testing uptake and frequency, particularly for those with complex relationships with clinical services.
SELPHI was prospectively registered with the ISRCTN (ref: ISRCTN 20312003 ).
HIV 自我检测（HIVST）可以在改善检测获取途径方面发挥重要作用，从而减少与 HIV 晚期诊断相关的不平等，同时也可以改善获得 HIV 预防干预措施的途径，例如 HIV 暴露前预防。本研究通过探索在同性恋场所活动并了解 HIV 检测规范的传播情况、获得 HIV 检测服务的经历、HIVST 的可接受性以及对干预措施调整的偏好，来了解 HIVST 的潜在作用。
对参加 SELPHI（HIVST 随机对照试验）的亚洲、黑人和拉丁美洲男男性行为者（MSM）进行了 29 次定性访谈。主题包括 HIV 检测史、HIV 检测模式、获得性健康服务的经历、心理健康、对 HIVST 和 SELPHI 的参与情况，以及对同性恋场所的经历。访谈内容进行了录音、转录，然后使用主题框架进行分析。
同性恋场所被认为是了解 HIV 和接触强化保护行为重要性的规范的重要场所。然而，由于对现场的“白人”的看法或种族主义经历而产生的不适感，可能会阻碍现场在制定影响 HIV 检测行为的规范方面发挥保护作用。在诊所候诊室感到不适被认为是获得临床服务的一个实质性障碍，许多受访者对医疗保健提供者的个人特征表示了偏好。HIVST 被认为是可以接受的，一些受访者建议对 HIVST 服务进行潜在的调整，例如将 HIVST 与家庭性传播感染检测选项相结合。
HIVST 针对亚洲、黑人和拉丁美洲 MSM 所经历的一些服务获取障碍做出了回应。将 HIV 检测与就诊分开，对于少数民族背景的 MSM 可能特别有价值，他们由于担心隐含的披露问题，可能比白人 MSM 更强烈地在诊所候诊室感到焦虑和不适。这表明 HIVST 有可能增加检测的采用率和频率，特别是对那些与临床服务关系复杂的人。
SELPHI 前瞻性地在 ISRCTN（参考：ISRCTN 20312003）进行了注册。
