For a variety of reasons, a number of people are not being tested in Australia. And according to national surveillance data there is significant risk for some MSM and bisexual people and particularly amongst those who use drugs and are over 50 years may have had missed opportunities to be tested. In addition, populations that are born in countries other than Australia also are under tested groups.
HIVST kits are becoming an option for difficult to reach populations and have had pilots in Queensland and New Zealand. Responses to questionnaires indicate that some under tested groups have found that HIVST has good uptake for those with previously untested population such as bisexual and MSM in indigenous, transient or remote locations.
The benefits from these are reported, and proved to be an accessible option, simple and easy to use, discreet, and convenient. The positive feedback about the kits also reflected they were well supported by peer testers over the phone, with clear written or video instructions, and supported by trained peer staff.
It wasn’t really discussed at the session but the complexities of pre-test (and post) counselling came to my mind, but perhaps this group of the population who are already seeking HIV testing, generally surfing online, already have an understanding of implications of this test.
And nearby overseas in Indonesia I heard about HIVST for men who were purchasing sex in Indonesia, provided an interesting perspective on self testing too. The men who were approached at brothels reported appreciated HIVST due to privacy and ease of the testing. They could take the test at home or be guided by lay workers on the spot. Although the follow up of potential reactive test was unclear, the ease of access to testing for this high risk population was well regarded.
This is a high risk population due to poor condom use, high drug use, multiple partners, and low rates of testing, so improved access to testing is an advantage to long term health outcomes and economic benefits.
It would appear that this style of non-invasive and simple tool for HIVST might be essential to the future of testing hard to reach and under tested groups in our local communities. It appears overwhelmingly acceptable and convenient for people to test in the privacy of their own home and it seems to remove the anxiety from being tested in traditional medical services. Hopefully the concepts to help engage and ensure ways to test for HIV in under tested groups, and also perhaps their contacts or partners.
Katie Costello is a Registered Nurse who first worked in HIV field in the early 1990s as a Clinical Nurse at the Alfred Hospital in Melbourne. She completed her Graduate diploma of advanced nursing in 1994 and worked as a clinical teacher with Victoria University. She worked at Alfred Hospital as HIV Community Liaison and with the Victorian NPEP telephone service from its inception in 2006. She is currently sharing the role of HIV coordinator at Monashhealth.