HIV self-testing reduces barriers associated with other HIV testing services, such as concerns about confidentiality and inconvenience. This article demonstrates who might benefit from this approach to HIV testing by describing the characteristics of men who have sex with men (MSM) who took interest in a Norwegian pilot project on HIV self-testing. Of the MSM users, 27% reported that they had never been tested for HIV. Not disclosing one’s same-sex sexuality, particularly among non-gay-identified MSM, was associated with a higher probability of never having been tested for HIV and choosing to test with an HIV self-test because of its anonymity. Never having been tested for HIV was also associated with a higher probability of choosing to test with an HIV self-test due to anonymity. The results suggest that the HIV self-tests’ ability to reach MSM who otherwise would not be tested is partly because it is an anonymous HIV testing alternative.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
(1) Less than 3 months ago, (2) between 13 weeks and 6 months ago, (3) between 7 months and 1 year ago, (4) between 13 months and 2 years ago, (5) between more than 2 years and 4 years ago, (6) between more than 4 years and 9 years ago, (7) more than 10 years ago, and (8) I can’t answer (only one respondent in this category, who was excluded).
(1) Yes, all close family members know that I have sex with men, (2) Yes, most close family members know that I have sex with men, (3) Yes, a few close family members know that I have sex with men, (4) No, nobody in my family knows that I have sex with men, (5) I don’t know if somebody knows, (6) I don’t have any family/I don’t have any contact with my family, (7) I don’t have sexual relationships with men (responses in this category are excluded).
(1) None, (2) 1, (3) 2, (4) 3–4, (5) 5–9, (6) 10–14, (7) 15–19, (8) 20–29, (9) 30–39, (10) 40–49, (11) 50–99, (12) 100–199, (13) 200+.
World Health Organization. WHO recommends HIV self-testing. Policy brief. 2016. https://www.who.int/hiv/pub/vct/who-recommends-hiv-self-testing/en/. Accessed 25 Feb 2019.
World Health Organization. Consolidated guidelines on HIV testing services. Geneva: WHO. 2015. https://www.who.int/hiv/pub/guidelines/hiv-testing-services/en/. Accessed 25 Feb 2019.
Jakopanec I, Grjibovski AM, Nilsen Ø, Blystad H, Aavitsland P. Trends in HIV infection surveillance data among men who have sex with men in Norway, 1995–2011. BMC Public Health. 2013;13:144. https://doi.org/10.1186/1471-2458-13-144.
Folkehelseinstituttet: Hivsituasjonen i Norge per 31. 2017. 2018. https://www.fhi.no/globalassets/dokumenterfiler/seksuelt-overforbare-infeksjoner/hiv-arsoppgjor-2017.pdf. Accessed 25 Feb 2019.
Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006;20(10):1447–50. https://doi.org/10.1097/01.aids.0000233579.79714.8d.
Delpierre C, Lauwers-Cances V, Pugliese P, et al. Characteristics trends, mortality and morbidity in persons newly diagnosed HIV positive during the last decade: the profile of new HIV diagnosed people. Eur J Public Health. 2008;18(3):345–7. https://doi.org/10.1093/eurpub/ckm117.
Waters L, Sabin CA. Late HIV presentation: epidemiology, clinical implications and management. Expert Rev Anti Infect Ther. 2011;9(10):877–89. https://doi.org/10.1586/eri.11.106.
World Health Organization 2014. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. 2016 update. 2014. https://apps.who.int/iris/bitstream/handle/10665/128048/9789241507431_eng.pdf?sequence=1. Accessed 25 Feb 2019.
Nardone A, Delpech V, Gill ON, Fenton KA, Anderson J. HIV in the UK: test, test, and test again. Lancet. 2013;382(9906):1687–8. https://doi.org/10.1016/s0140-6736(13)62377-6.
Phillips AN, Cambiano V, Miners A, et al. Potential impact on HIV incidence of higher HIV testing rates and earlier antiretroviral therapy initiation in MSM. AIDS. 2015;29(14):1855–62. https://doi.org/10.1097/qad.0000000000000767.
DiNenno EA, Prejean J, Irwin K, et al. Recommendations for HIV screening of gay, bisexual, and other men who have sex with men—United States, 2017. MMWR Morb Mortal Wkly Rep. 2017;66(31):830–2. https://doi.org/10.15585/mmwr.mm6631a3.
Folkehelseinstituttet. Menn som har sex med menn og smittevern – veileder for helsepersonell. 2010. https://www.fhi.no/nettpub/smittevernveilederen/temakapitler/14.-menn-som-har-sex-med-menn-og-sm/#epidemiologisk-situasjon-blant-msm-i-norg. Accessed 25 Feb 2019.
Flowers P, Knussen C, Li J, McDaid L. Has testing been normalized? An analysis of changes in barriers to HIV testing among men who have sex with men between 2000 and 2010 in Scotland, UK. HIV Med. 2012;14(2):92–8.
Prosjektteamet EMIS Norge. Rapport fra EMIS 2010 - Europeisk menn som har sex med menn internettundersøkelse: Norske resultater. 2012. https://www.fhi.no/globalassets/dokumenterfiler/rapporter/2012/europeisk-menn-som-har-sex-med-menn-internettundersokelse-norske-resultater-rapport-fra-emis-2010.pdf. Accessed 25 Feb 2019.
Jakopanec I, Schimmer B, Grjibovski AM, Klouman E, Aavitsland P. Self-reported sexually transmitted infections and their correlates among men who have sex with men in Norway: an internet-based cross-sectional survey. BMC Infect Dis. 2010;10:261. https://doi.org/10.1186/1471-2334-10-261.
Mercer CH, Fenton KA, Copas AJ, et al. Increasing prevalence of male homosexual partnerships and practices in Britain 1990–2000: evidence form national probability surveys. AIDS. 2004;18(10):14531458.
Mercer CH, Prah P, Field N, et al. The health and well-being of men who have sex with men (MSM) in Britain: evidence from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMC Public Health. 2016;16:525. https://doi.org/10.1186/s12889-016-3149-z.
Prah P, Hickson F, Bonell C, et al. Men who have sex with men in Great Britain: comparing methods and estimates from probability and convenience sample surveys. Sex Transm Infect. 2016;92:455–63. https://doi.org/10.1136/sextrans-2015-052389.
Copen CE, Chandra A, Febo-Vazquez I. National Center for Health Statistics. HIV testing in the past year among the US household population aged 15–44: 2011–2013. 2015. NCHS data brief no 202. 2015. https://www.cdc.gov/nchs/data/databriefs/db202.pdf. Accessed 27 Feb 2019.
Sonnenberg P, Clifton S, Beddows S, et al. Prevalence, risk factors, and uptake of interventions for sexually transmitted infections in Britain: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). Lancet. 2013;382:1795–806. https://doi.org/10.1016/S0140-6736(13)61947-9.
Witzel TC, Melendez-Torres GJ, Hickson F, et al. HIV testing history and preferences for future tests among gay men, bisexual men and other MSM in England: results from a cross-sectional study. BMJ Open. 2016;6:e011372. https://doi.org/10.1136/bmjopen-2016-011372.
Manning SE, Thorpe LE, Ramaswamy C, et al. Estimation of HIV prevalence, risk factors, and testing frequency among sexually active men who have sex with men, aged 18–64 years—New York City, 2002. J Urban Health. 2007;84(2):212–25. https://doi.org/10.1007/s11524-006-9135-5.
den Daas C, Doppen M, Schmidt AJ, et al. Determinants of never having tested for HIV among MSM in the Netherlands. BMJ Open. 2016;6:e009480. https://doi.org/10.1136/bmjopen-2015-009480.
Clifton S, Nardone A, Field N, et al. HIV testing, risk perception, and behaviour in the British population. AIDS. 2016;30:943–51. https://doi.org/10.1097/QAD.0000000000001006.
Zablotska I, Holt M, de Wit J, et al. Gay men who are not getting tested for HIV. AIDS Behav. 2012;16:1887–94. https://doi.org/10.1007/s10461-012-0184-3.
Nelson KM, Pantalone DW, Gamarel KE. Correlates of never testing for HIV among sexually active internet-recruited gay, bisexual, and other men who have sex with men in the United States. AIDS Patient Care STDS. 2018;32(1):9–15. https://doi.org/10.1089/apc.2017.0244.
Deblonde J, De Koker P, Hamers FF, Fontaine J, Luchters S, Temmerman M. Barriers to HIV testing in Europe: a systematic review. Eur J Public Health. 2010;20(4):422–32. https://doi.org/10.1093/eurpub/ckp231.
Berg RC. Predictors of never testing for HIV among a national online sample of men who have sex with men in Norway. Scand J Public Health. 2013;41(4):398–404. https://doi.org/10.1177/1403494813483216.
Margolis AD, Joseph H, Belcher L, Hirshfield S, Chiasson MA. ‘Never testing for HIV’ among men who have sex with men recruited from a sexual networking website, United States. AIDS Behav. 2012;16:23. https://doi.org/10.1007/s10461-011-9883-4.
Conway DP, Holt M, Couldwell DL, et al. Barriers to HIV testing and characteristics associated with never testing among gay and bisexual men attending sexual health clinics in Sydney. J Int AIDS Soc. 2015;18(1):20221. https://doi.org/10.7448/IAS.18.1.20221.
Witzel TC, Rodger AJ, Burns FM, Rhodes T, Weatherburn P. HIV self-testing among men who have sex with men (MSM) in the UK: a qualitative study of barriers and facilitators, intervention preferences and perceived impacts. PLoS ONE. 2016;11(9):e0162713. https://doi.org/10.1371/journal.pone.0162713.
Flowers P, Estcourt C, Sonnenberg P, Burns F. HIV testing intervention development among men who have sex with men in the developed world. Sex Health. 2017;14:80–8. https://doi.org/10.1071/SH16081.
Campbell CK, Lippman SA, Moss N, et al. Strategies to increase HIV testing among MSM: a synthesis of the literature. AIDS Behav. 2018;22:2387. https://doi.org/10.1007/s10461-018-2083-8.
Frye V, Koblin BA. HIV self-testing in high-risk populations. Lancet HIV. 2017;4(6):e232–3. https://doi.org/10.1016/S2352-3018(17)30024-3.
Johnson CC, Kennedy C, Fonner V, et al. Examining the effects of HIV self-testing compared to standard HIV testing services: a systematic review and meta-analysis. J Int AIDS Soc. 2017;20(1):21594. https://doi.org/10.7448/IAS.20.1.21594.
Katz DA, Golden MR, Hughes JP, Farquhar C, Stekler JD. HIV self-testing increases HIV testing frequency in high-risk men who have sex with men: a randomized controlled trial. J Acquir Immune Defic Syndr. 2018;78(5):505–12. https://doi.org/10.1097/QAI.0000000000001709.
Jamil M, Prestage G, Fairley CK, et al. Effect of availability of HIV self-testing on HIV testing frequency in gay and bisexual men at high risk of infection (FORTH): a waiting-list randomised controlled trial. Lancet HIV. 2017;4(6):e241–50. https://doi.org/10.1016/S2352-3018(17)30023-1.
Wang Z, Lau JTF, Ip M, et al. A randomized controlled trial evaluating efficacy of promoting a home-based HIV self-testing with online counseling on increasing HIV testing among men who have sex with men. AIDS Behav. 2018;22:190. https://doi.org/10.1007/s10461-017-1887-2.
Zhang C, Li X, Brecht M-L, Koniak-Griffin D. Can self-testing increase HIV testing among men who have sex with men: a systematic review and meta-analysis. PLoS ONE. 2017;12(11):e0188890. https://doi.org/10.1371/journal.pone.0188890.
Mavedzenge SN, Baggaley R, Corbett EL. A review of self-testing for HIV: research and policy priorities in a new era of HIV prevention. Clin Infect Dis. 2015;57(1):126–38. https://doi.org/10.1093/cid/cit156.
Pai PN, Sharma J, Shivkumar S, et al. Supervised and unsupervised self-testing for HIV in high- and low-risk populations: a systematic review. PloS Med. 2013;10(4):e1001414. https://doi.org/10.1371/journal.pmed.1001414.
Spielberg F, Levine RO, Weaver M. Self-testing for HIV: a new option for HIV prevention? Lancet. 2004;4(10):640–6. https://doi.org/10.1016/S1473-3099(04)01150-8.
Greacen T, Friboulet D, Fugon L, et al. Access to and use of unauthorised online HIV self-tests by internet-using French-speaking men who have sex with men. Sex Transm Infect. 2012;88:368–74. https://doi.org/10.1136/sextrans-2011-050405.
Greacen T, Friboulet D, Blachier A. Internet-using men who have sex with men would be interested in accessing authorised HIV self-tests available for purchase online. AIDS Care. 2013;25(1):49–54. https://doi.org/10.1080/09540121.2012.687823.
Greacen T, Kersaudy-Rahib D, Le Gall J-M, Lydié N, Ghosn J, Champenois K. Comparing the information and support needs of different population groups in preparation for 2015 government approval for HIV self-testing in France. PLoS ONE. 2016;11(3):e0152567. https://doi.org/10.1371/journal.pone.0152567.
Wood BR, Ballenger C, Stekler JD. Arguments for and against HIV self-testing. HIV/AIDS. 2014;6:117–26. https://doi.org/10.2147/HIV.S49083.
Krause J, Subklew-Sehume F, Kenyon C, Colebunders R. Acceptability of HIV self-testing: a systematic literature review. BMC Public Health. 2013;13:735. https://doi.org/10.1186/1471-2458-13-735.
Moseng BU, Bjørnshagen V. Are there any differences between different testing sites? A cross-sectional study of a Norwegian low-threshold HIV testing service for men who have sex with men. BMJ Open. 2017;7:e017598. https://doi.org/10.1136/bmjopen-2017-017598.
Wall KM, Khosropour CM, Sullivan PS. Offering of HIV screening to men who have sex with men by their health care providers and associated factors. J Int Assoc Physicians AIDS Care. 2010;9(5):284–8. https://doi.org/10.1177/1545109710379051.
Bernstein KT, Liu K, Begier EM, Koblin B, Karpati A, Murrill C. Same-sex attraction disclosure to health care providers among New York city men who have sex with men: implications for HIV testing approaches. Arch Intern Med. 2008;168(13):1458–64. https://doi.org/10.1001/archinte.168.13.145.
Qiao S, Zhou G, Li X. Disclosure of same-sex behaviors to health-care providers and uptake of HIV testing for men who have sex with men: a systematic review. Am J Mens Health. 2018;12(5):1197–214. https://doi.org/10.1177/1557988318784149.
Yang C, Krishnan N, Painter JE, Latkin, C. The association between disclosure of same sex behavior to healthcare providers and PrEP awareness among BMSM in Baltimore. AIDS Behav. 2019. https://doi.org/10.1007/s10461-019-02401-2.
Geary RS, Tanton C, Erens B, et al. Sexual identity, attraction and behaviour in Britain: the implications of using different dimensions of sexual orientation to estimate the size of sexual minority populations and inform public health interventions. PLoS ONE. 2018;13(1):e0189607. https://doi.org/10.1371/journal.pone.0189607.
White H. A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica. 1980;48(4):817–38. https://doi.org/10.2307/1912934.
Cameron AC, Trivedi PK. Microeconometrics using stata, Revised Edition. College Station: STATA Press; 2010.
Woods WJ, Lippman SA, Agnew E, Carroll S, Binson D. Bathhouse distribution of HIV self-testing kits reaches diverse, high-risk population. AIDS Care. 2016;28(sup1):111–3.
Mercer CH. Measuring sexual behaviour and risk. 2010. https://www.ukdataservice.ac.uk/media/262883/discover_sqb_sex_mercer.pdf. Accessed 12 Mar 2018.
Mitchell KR, Mercer CH, Ploubidis GB, et al. Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet. 2013;382:1817–29. https://doi.org/10.1016/S0140-6736(13)62366-1.
Bain LE, Nkoke C, Noubiap JJN. UNAIDS 90–90–90 targets to end the AIDS epidemic by 2020 are not realistic: comment on “Can the UNAIDS 90–90–90 target be achieved? A systematic analysis of national HIV treatment cascades”. BMJ Glob Health. 2017;2:e000227. https://doi.org/10.1136/bmjgh-2016-000227.
The authors wish to thank two anonymous referees for many helpful comments.
Conflict of interest
All authors declare that they have no conflicts of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Bjørnshagen, V., Moseng, B.U. & Ugreninov, E. Who Do You Reach? A Norwegian Pilot Project on HIV Self-Testing that Targeted Men Who Have Sex with Men. AIDS Behav 24, 568–579 (2020). https://doi.org/10.1007/s10461-019-02484-x
- HIV self-testing
- Barriers to HIV testing