Background. We aimed to identify factors associated with recent HIV testing in MSM who attended two experimental community-based and nonmedicalized voluntary counselling and testing programmes (CB-VCT) targeting MSM in France. Methods. This analysis was based on data collected in 2009–2011 through a self-administered pretesting questionnaire. An index measuring the level of participants’ sexual orientation disclosure was built: the higher the index, the greater the disclosure. Factors associated with recent HIV testing (last test ≤ 1 year) were identified using a multivariate logistic regression model adjusted for the CB-VCT programme of enrolment. Results. 716 MSM provided data on testing history. Overall, 49% were recently tested for HIV and 51% were not. Recently tested MSM had a higher homosexuality disclosure index (adjusted OR [95% confidence interval]: aOR = 1.2 [1.1–1.4]), reported more inconsistent condom use during anal sex with men (aOR = 1.6 [1.2–2.1]), and were less likely to have sex under the influence of club drugs (aOR = 0.6 [0.4–1.0]). Conclusion. New testing strategies should focus on those who live their homosexuality relatively secretly and those who use club drugs before sex. Governments should develop policies which encourage improved social acceptance of homosexuality as concealment of sexual orientation represents a major barrier to testing. 1. Introduction In resource-rich countries, men who have sex with men (MSM) are greatly affected by the HIV burden [1–7], including France where they account for 40% of the annual new diagnoses [8]. The French HIV incidence in MSM is 60 times higher than that in the overall population [2]. Although a large proportion of MSM have already been tested for HIV in France [7, 9, 10], it is estimated that they account for 31% of the hidden epidemic [11] and for 19% of the diagnoses made at an advanced disease stage in 2011 (CD4 < 200/mm3, [8]). HIV testing has now become a tool to limit the HIV epidemic [12] and is a recognized element of combination prevention based on biomedical (preexposure prophylaxis, treatment as prevention) and behavioural (mainly serosorting and positioning) tools [13–17]. Indeed, knowledge of HIV serostatus is the cornerstone of successful combination prevention, as the latter’s implementation is adapted according to the individual’s serological status. In France, just as in the USA, guidelines encourage the extension of HIV testing and recommend annual testing of certain population groups at high risk of acquiring HIV, in particular MSM [18–20]. Early detection of HIV
References
[1]
J. Prejean, R. Song, A. Hernandez et al., “Estimated HIV incidence in the United States, 2006–2009,” PLoS ONE, vol. 6, no. 8, Article ID e17502, 2011.
[2]
S. Le Vu, Y. Le Strat, F. Barin et al., “Population-based HIV-1 incidence in France, 2003–08: a modelling analysis,” The Lancet Infectious Diseases, vol. 10, no. 10, pp. 682–687, 2010.
[3]
S. Le Vu, A. Velter, L. Meyer, et al., “Biomarker-based HIV incidence in a community sample of men who have sex with men in Paris, France,” PLoS ONE, vol. 7, Article ID e39872, 2012.
[4]
G. Likatavicius and M. J. van de Laar, “HIV and AIDS in the European Union, 2008,” Euro Surveill, vol. 14, no. 47, 2009.
[5]
T. J. Finlayson, B. Le, A. Smith et al., “HIV risk, prevention, and testing behaviors among men who have sex with men—national HIV behavioral surveillance system, 21 U.S. Cities, United States, 2008,” Morbidity and Mortality Weekly Report, vol. 60, no. 14, pp. 1–34, 2011.
[6]
I. A. V. Jansen, R. B. Geskus, U. Davidovich et al., “Ongoing HIV-1 transmission among men who have sex with men in Amsterdam: a 25-year prospective cohort study,” AIDS, vol. 25, no. 4, pp. 493–501, 2011.
[7]
A. Velter, F. Barin, A. Bouyssou, et al., “HIV prevalence and sexual risk behaviors associated with awareness of HIV status among men who have sex with men in Paris, France,” AIDS and Behavior, vol. 17, no. 4, pp. 1266–1278, 2012.
[8]
F. Cazein, Y. Le Strat, J. Pillonel, et al., “HIV testing and new HIV diagnoses, France, 2003–2010,” Bulletin épidémiologique Hebdomadaire, vol. 44, pp. 43–8, 2011.
[9]
A. Velter, A. Bouyssou-Michel, J. Pillonel, G. Jacquier, and C. Semaille, “Baromètre gay 2005: enquête auprès des hommes fréquentant les lieux de rencontre gay franciliens,” Bulletin épidémiologique Hebdomadaire, vol. 25, pp. 178–180, 2006.
[10]
A. Schmidt, U. Marcus, M. Breveglieri, et al., “Individual level and country level predictors for recent HIV-testing and late HIV diagnoses among MSM in Europe-aspects to consider when planning interventions to increase HIV-testing. Results of the European MSM Internet Survey (EMIS),” in HIV in Europe, Copenhagen, Denmark, 2012.
[11]
V. Supervie, J. D. Ndawinz, and D. Costagliola, “How to estimate the size of the hidden HIV epidemic? The case of France HIV,” in Proceedings of the Europe Conference, HIV in Europe, Copenhagen, Danmark, 2012.
[12]
R. M. Granich, C. F. Gilks, C. Dye, K. M. De Cock, and B. G. Williams, “Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model,” The Lancet, vol. 373, no. 9657, pp. 48–57, 2009.
[13]
S. Attia, M. Egger, M. Müller, M. Zwahlen, and N. Low, “Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis,” AIDS, vol. 23, no. 11, pp. 1397–1404, 2009.
[14]
M. S. Cohen, Y. Q. Chen, M. McCauley et al., “Prevention of HIV-1 infection with early antiretroviral therapy,” The New England Journal of Medicine, vol. 365, no. 6, pp. 493–505, 2011.
[15]
R. M. Grant, J. R. Lama, P. L. Anderson et al., “Preexposure chemoprophylaxis for HIV prevention in men who have sex with men,” The New England Journal of Medicine, vol. 363, no. 27, pp. 2587–2599, 2010.
[16]
G. J. Hart and J. Elford, “Sexual risk behaviour of men who have sex with men: emerging patterns and new challenges,” Current Opinion in Infectious Diseases, vol. 23, no. 1, pp. 39–44, 2010.
[17]
L. M. McDaid and G. J. Hart, “Sexual risk behaviour for transmission of HIV in men who have sex with men: recent findings and potential interventions,” Current Opinion in HIV and AIDS, vol. 5, no. 4, pp. 311–315, 2010.
[18]
H. A. de Santé, Recommandations en santé publique—Dépistage de l'infection par le VIH en France—Stratégies et dispositif de dépistage, 2009.
[19]
Y. Yazdanpanah, C. E. Sloan, C. Charlois-Ou et al., “Routine HIV screening in France: clinical impact and cost-effectiveness,” PLoS ONE, vol. 5, no. 10, Article ID e13132, 2010.
[20]
K. A. Workowski and S. M. Berman, “Sexually transmitted diseases treatment guidelines, 2006,” Morbidity and Mortality Weekly Report, vol. 55, no. -11, pp. 1–94, 2006.
[21]
T. C. Quinn, M. J. Wawer, N. Sewankambo et al., “Viral load and heterosexual transmission of human immunodeficiency virus type 1,” The New England Journal of Medicine, vol. 342, no. 13, pp. 921–929, 2000.
[22]
H. Irene Hall, D. R. Holtgrave, and C. Maulsby, “HIV transmission rates from persons living with HIV who are aware and unaware of their infection,” AIDS, vol. 26, no. 7, pp. 893–896, 2012.
[23]
D. A. MacKellar, S.-I. Hou, C. C. Whalen et al., “Reasons for not HIV testing, testing intentions, and potential use of an over-the-counter rapid HIV test in an internet sample of men who have sex with men who have never tested for HIV,” Sexually Transmitted Diseases, vol. 38, no. 5, pp. 419–428, 2011.
[24]
S. Schwarcz, T. A. Richards, H. Frank et al., “Identifying barriers to HIV testing: personal and contextual factors associated with late HIV testing,” AIDS Care, vol. 23, no. 7, pp. 892–900, 2011.
[25]
J. Deblonde, P. De Koker, F. F. Hamers, J. Fontaine, S. Luchters, and M. Temmerman, “Barriers to HIV testing in Europe: a systematic review,” European Journal of Public Health, vol. 20, no. 4, pp. 422–432, 2010.
[26]
B. Spire, I. de Zoysa, and H. Himmich, “HIV prevention: what have we learned from community experiences in concentrated epidemics?” Journal of the International AIDS Society, vol. 11, article 5, 2008.
[27]
K. Champenois, J. M. Le Gall, C. Jacquemin, et al., “ANRS-COM'TEST: description of a community-based HIV testing intervention in non-medical settings for men who have sex with men,” BMJ Open, vol. 2, Article ID e000693, 2012.
[28]
N. Lorente, M. Preau, C. Vernay-Vaisse, et al., “Expanding access to non-medicalized community-based rapid testing to men who have sex with men: an urgent HIV prevention intervention (The ANRS-DRAG Study),” PLoS ONE, vol. 8, Article ID e61225, 2013.
[29]
W. R. Miller and S. Rollnick, “Motivational interviewing,” in Preparing People To Change Addictive Behavior, Guilford Press, New York, NY, USA, 2nd edition, 2002.
[30]
Arrêté du 9 novembre 2010 fixant les conditions de réalisation des tests rapides d'orientation diagnostique de l'infection à virus de l'immunodéficience humaine (VIH 1 et 2), pp. 20499–20506, 2010.
[31]
M. Desai, S. Desai, A. K. Sullivan, et al., “Audit of HIV testing frequency and behavioural interventions for men who have sex with men: policy and practice in sexual health clinics in England,” Sexually Transmitted Infections, vol. 89, no. 5, pp. 404–408, 2013.
[32]
M. Holt, P. Rawstorne, J. Wilkinson, H. Worth, M. Bittman, and S. Kippax, “HIV testing, gay community involvement and internet use: social and behavioural correlates of HIV testing among Australian men who have sex with men,” AIDS and behavior, vol. 16, no. 1, pp. 13–22, 2012.
[33]
D. A. Mackellar, L. A. Valleroy, J. E. Anderson et al., “Recent HIV testing among young men who have sex with men: correlates, contexts, and HIV seroconversion,” Sexually Transmitted Diseases, vol. 33, no. 3, pp. 183–192, 2006.
[34]
L. M. McDaid and G. J. Hart, “Increased HIV testing and reduced undiagnosed infection among gay men in Scotland, 2005–8: support for the opt-out testing policy?” Sexually Transmitted Infections, vol. 87, no. 3, pp. 221–224, 2011.
[35]
M. C. Parent, C. Torrey, and M. S. Michaels, “‘HIV testing is so gay’: the role of masculine gender role conformity in HIV testing among men who have sex with men,” Journal of Counseling Psychology, vol. 59, pp. 465–470, 2012.
[36]
E. Sumartojo, C. Lyles, K. Choi et al., “Prevalence and correlates of HIV testing in a multi-site sample of young men who have sex with men,” AIDS Care, vol. 20, no. 1, pp. 1–14, 2008.
[37]
U. Marcus, A. J. Schmidt, R. Berg, et al., “Differences in association between HIV testing and risk taking among men having sex with men accross Europe-results of the European MSM Internet Survey (EMIS). Abstract TUPE492,” in XIX international AIDS conference, Washington, DC, USA, 2012.
[38]
T. Greacen, D. Friboulet, L. Fugon, S. Hefez, N. Lorente, and B. Spire, “Access to and use of unauthorised online HIV self-tests by internet-using French-speaking men who have sex with men,” Sexually Transmitted Infections, vol. 25, pp. 49–54, 2012.
[39]
T. Greacen, D. Friboulet, L. Fugon, S. Hefez, N. Lorente, and B. Spire, “Access to and use of unauthorised online HIV self-tests by internet-using French-speaking men who have sex with men,” Sexually Transmitted Infections, vol. 88, pp. 368–374, 2012.
[40]
G. J. Wagner, F. M. Aunon, R. L. Kaplan, et al., “Qualitative exploration of sexual risk and HIV testing behaviors among men who have sex with men in Beirut, Lebanon,” PLoS ONE, vol. 7, Article ID e45566, 2012.
[41]
TNS Opinion & Social, “Eurobarometer 393. Discrimination in the EU in 2012,” in European Commission, 2012.
[42]
L. Dowson, C. Kober, N. Perry, M. Fisher, and D. Richardson, “Why some MSM present late for HIV testing: a qualitative analysis,” AIDS Care, vol. 24, no. 2, pp. 204–209, 2012.
[43]
G. Mansergh, S. Flores, B. Koblin, S. Hudson, D. McKirnan, and G. N. Colfax, “Alcohol and drug use in the context of anal sex and other factors associated with sexually transmitted infections: results from a multi-city study of high-risk men who have sex with men in the USA,” Sexually Transmitted Infections, vol. 84, no. 6, pp. 509–511, 2008.
[44]
D. G. Ostrow, M. W. Plankey, C. Cox et al., “Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS,” Journal of Acquired Immune Deficiency Syndromes, vol. 51, no. 3, pp. 349–355, 2009.
[45]
G. Lambert, J. Cox, T. S. Hottes et al., “Correlates of unprotected anal sex at last sexual episode: analysis from a surveillance study of men who have sex with men in Montreal,” AIDS and Behavior, vol. 15, no. 3, pp. 584–595, 2011.
[46]
K. Champenois, A. Cousien, B. Ndiaye, et al., “Risk factors for syphilis infection in men who have sex with men: results of a case-control study in Lille, France,” Sexually Transmitted Infections, vol. 89, pp. 128–132, 2013.
[47]
D. P. MacKinnon, J. L. Krull, and C. M. Lockwood, “Equivalence of the mediation, confounding and suppression effect,” Prevention Science, vol. 1, no. 4, pp. 173–181, 2000.
[48]
G. H. Maassen and A. B. Bakker, “Suppressor variables in path models: definitions and interpretations,” Sociological Methods and Research, vol. 30, no. 2, pp. 241–270, 2001.
