Abstract
Cisgender men who have sex with men (cMSM) and transgender women (TGW) are disproportionally burdened by HIV. Among these populations, HIV partner-testing is a highly acceptable harm reduction tool. Particularly, cMSM and TGW report a stronger preference for blood-based tests that include assays for multiple STIs. However, no existing research has explored how these populations negotiate blood-based testing with sexual partners. In the SMARTtest study, 48 sexually active cMSM and TGW took home dual, blood-based HIV/Syphilis kits for self- and partner-testing. After 3 months, they completed a follow-up assessment and in-depth interviews about their experiences initiating testing. Of the 42 responding participants, 27 (64%) reported that it had been “fairly” or “very easy” to raise the idea of testing with partners. Participants predominantly employed partner-conscious communication strategies, including framing the testing proposal as a mandatory, non-personal component of their participation in a research study, gradually incorporating testing mentions into discussions about sexual health, and using the kits to facilitate joint testing. Yet, 21 (44%) participants reported having sex with at least one partner they did not ask to test. Concern regarding partner reactions emerged as a significant barrier to discussing test use; similarly, many partners were averse to taking a blood-based test in the context of a casual sexual encounter. Nonetheless, these findings suggest that dual, blood-based HIV/STI rapid tests may represent acceptable harm reduction tools among similar populations of cMSM and TGW, particularly if future partner-testing research is broadened to consider key couples’ dynamics that may impact test usage.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Availability of Data and Material
All study data and materials support the published claims in this manuscript and comply with field standards. This manuscript has not been submitted to other journals for simultaneous consideration.
References
Balán, I. C., Carballo-Diéguez, A., Frasca, T., Dolezal, C., & Ibitoye, M. (2014). The impact of rapid HIV home test use with sexual partners on subsequent sexual behavior among men who have sex with men. AIDS and Behavior, 18(2), 254–262. https://doi.org/10.1007/s10461-013-0497-x
Balán, I., Frasca, T., Ibitoye, M., Dolezal, C., & Carballo-Diéguez, A. (2017). Fingerprick versus oral swab: Acceptability of blood-based testing increases if other STIs can be detected. AIDS and Behavior, 21(2), 501–504. https://doi.org/10.1007/s10461-016-1497-4
Balán, I. C., Lopez-Rios, J., Nayak, S., Lentz, C., Arumugam, S., Kutner, B., Dolezal, C., Macar, O. U., Pabari, T., Wang Ying, A., Okrah, M., & Sia, S. K. (2020). SMARTtest: A Smartphone app to facilitate HIV and syphilis self- and partner-testing, interpretation of results, and linkage to care. AIDS and Behavior, 24(5), 1560–1573. https://doi.org/10.1007/s10461-019-02718-y
Bilardi, J. E., Walker, S., Read, T., Prestage, G., Chen, M. Y., Guy, R., Bradshaw, C., & Fairley, C. K. (2013). Gay and bisexual men’s views on rapid self-testing for HIV. AIDS and Behavior, 17(6), 2093–2099. https://doi.org/10.1007/s10461-012-0395-7
Carballo-Diéguez, A., Frasca, T., Balán, I., Ibitoye, M., & Dolezal, C. (2012). Use of a rapid HIV home test prevents HIV exposure in a high-risk sample of men who have sex with men. AIDS and Behavior, 16(7), 1753–1760. https://doi.org/10.1007/s10461-012-0274-2
Choko, A. T., Desmond, N., Webb, E. L., Chavula, K., Napierala-Mavedzenge, S., Gaydos, C. A., Makombe, S. D., Chunda, T., Squire, S. B., French, N., Mwapasa, V., & Corbett, E. L. (2011). The uptake and accuracy of oral kits for HIV self-testing in high HIV prevalence setting: A cross-sectional feasibility study in Blantyre Malawi. PLoS Medicine, 8(10), e1001102. https://doi.org/10.1371/journal.pmed.1001102
Feldman, J., Romine, R. S., & Bockting, W. O. (2014). HIV risk behaviors in the U.S. transgender population: Prevalence and predictors in a large internet sample. Journal of Homosexuality, 61(11), 1558–1588. https://doi.org/10.1080/00918369.2014.944048
Figueroa, C., Johnson, C., Verster, A., & Baggaley, R. (2015). Attitudes and acceptability on HIV self-testing among key populations: A literature review. AIDS and Behavior, 19(11), 1949–1965. https://doi.org/10.1007/s10461-015-1097-8
Flowers, P., Riddell, J., Park, C., Ahmed, B., Young, I., Frankis, J., Davis, M., Gilbert, M., Estcourt, C., Wallace, L., & McDaid, L. M. (2017). Preparedness for use of the rapid result HIV self-test by gay men and other men who have sex with men (MSM): A mixed methods exploratory study among MSM and those involved in HIV prevention and care. HIV Medicine, 18(4), 245–255. https://doi.org/10.1111/hiv.12420
Gaydos, C. A., Hsieh, Y. H., Harvey, L., Burah, A., Won, H., Jett-Goheen, M., Barnes, M., Agreda, P., Arora, N., & Rothman, R. E. (2011). Will patients “opt in” to perform their own rapid HIV test in the emergency department? Annals of Emergency Medicine, 58(1 Suppl 1), S74–S78. https://doi.org/10.1016/j.annemergmed.2011.03.029
Gichangi, A., Wambua, J., Mutwiwa, S., Njogu, R., Bazant, E., Wamicwe, J., Wafula, R., Vrana, C. J., Stevens, D. R., Mudany, M., & Korte, J. E. (2018). Impact of HIV self-test distribution to male partners of ANC clients: Results of a randomized controlled trial in Kenya. Journal of Acquired Immune Deficiency Syndromes, 79(4), 467–473. https://doi.org/10.1097/QAI.0000000000001838
Giguere, R., Lopez-Rios, J., Frasca, T., Lentz, C., Balán, I. C., Dolezal, C., Rael, C. T., Brown, W., 3rd., Sheinfil, A. Z., Cruz Torres, C., Crespo, R., Febo, I., & Carballo-Diéguez, A. (2020). Use of HIV self-testing kits to screen clients among transgender female sex workers in New York and Puerto Rico. AIDS and Behavior, 24(2), 506–515. https://doi.org/10.1007/s10461-019-02730-2
Grace, D., Chown, S. A., Jollimore, J., Parry, R., Kwag, M., Steinberg, M., Trussler, T., Rekart, M., & Gilbert, M. (2014). HIV-negative gay men’s accounts of using context-dependent sero-adaptive strategies. Culture, Health & Sexuality, 16, 316–330. https://doi.org/10.1080/13691058.2014.883644
Guest, G., MacQueen, K. M., & Namey, E. E. (2012). Applied thematic analysis. Sage Publications Inc.
Guest, G., Namey, E., & Chen, M. (2020). A simple method to assess and report thematic saturation in qualitative research. PLoS ONE, 15(5), e0232076. https://doi.org/10.1371/journal.pone.0232076
Hoff, C. C., & Beougher, S. C. (2010). Sexual agreements among gay male couples. Archives of Sexual Behavior, 39(3), 774–787. https://doi.org/10.1007/s10508-008-9393-2
Ibitoye, M., Frasca, T., Giguere, R., & Carballo-Diéguez, A. (2014). Home testing past, present and future: Lessons learned and implications for HIV home tests. AIDS and Behavior, 18(5), 933–949. https://doi.org/10.1007/s10461-013-0668-9
Iribarren, S., Lentz, C., Sheinfil, A. Z., Giguere, R., Lopez-Rios, J., Dolezal, C., Frasca, T., Balán, I. C., Tagliaferri Rael, C., Brown, W., 3rd., Cruz Torres, C., Crespo, R., Febo, I., & Carballo-Diéguez, A. (2020). Using an HIV self-test kit to test a partner: Attitudes and preferences among high-risk populations. AIDS and Behavior, 24(11), 3232–3243. https://doi.org/10.1007/s10461-020-02885-3
Krause, J., Subklew-Sehume, F., Kenyon, C., & Colebunders, R. (2013). Acceptability of HIV self-testing: A systematic literature review. BMC Public Health, 13, 735. https://doi.org/10.1186/1471-2458-13-735
Kubicek, K., McNeeley, M., & Collins, S. (2015). “Same-sex relationship in a straight world”: Individual and societal influences on power and control in young men’s relationships. Journal of Interpersonal Violence, 30(1), 83–109. https://doi.org/10.1177/0886260514532527
Lentz, C., Iribarren, S., Giguere, R., Conserve, D. F., Dolezal, C., Lopez-Rios, J., Balán, I. C., Sheinfil, A. Z., Rael, C. T., Brown, W., 3rd, Torres, C. C., Crespo, R., Febo, I., & Carballo-Diéguez, A. (2020). Broaching the topic of HIV self-testing with potential sexual partners among men and transgender women who have sex with men in New York and Puerto Rico. AIDS and Behavior, 24(11), 3033–3043. https://doi.org/10.1007/s10461-020-02851-z
Lippman, S. A., Lane, T., Rabede, O., Gilmore, H., Chen, Y. H., Mlotshwa, N., Maleke, K., Marr, A., & McIntyre, J. A. (2018). High acceptability and increased HIV-testing frequency after introduction of HIV self-testing and network distribution among South African MSM. Journal of Acquired Immune Deficiency Syndromes, 77(3), 279–287. https://doi.org/10.1097/QAI.0000000000001601
Lippman, S. A., Gilmore, H. J., Lane, T., Radebe, O., Chen, Y. H., Mlotshwa, N., Maleke, K., Manyuchi, A. E., & McIntyre, J. (2018a). Ability to use oral fluid and fingerstick HIV self-testing (HIVST) among South African MSM. PLoS ONE, 13(11), e0206849. https://doi.org/10.1371/journal.pone.0206849
Maman, S., Murray, K. R., Napierala Mavedzenge, S., Oluoch, L., Sijenje, F., Agot, K., & Thirumurthy, H. (2017). A qualitative study of secondary distribution of HIV self-test kits by female sex workers in Kenya. PLoS ONE, 12(3), e0174629. https://doi.org/10.1371/journal.pone.0174629
Masters, S. H., Agot, K., Obonyo, B., Napierala Mavedzenge, S., Maman, S., & Thirumurthy, H. (2016). Promoting partner testing and couples testing through secondary distribution of HIV self-tests: A randomized clinical trial. PLoS Medicine, 13(11), e1002166. https://doi.org/10.1371/journal.pmed.1002166
Matovu, J. K., Buregyeya, E., Arinaitwe, J., & Wanyenze, R. K. (2017). “…If you bring the kit home, you [can] get time and test together with your partner”: Pregnant women and male partners’ perceptions regarding female partner-delivered HIV self-testing in Uganda–A qualitative study. International Journal of STD & AIDS, 28(13), 1341–1347.
McFarland, W., Chen, Y. H., Nguyen, B., Grasso, M., Levine, D., Stall, R., Colfax, G., Robertson, T., Truong, H. M., & Raymond, H. F. (2012). Behavior, intention or chance? A longitudinal study of HIV seroadaptive behaviors, abstinence and condom use. AIDS and Behavior, 16(1), 121–131. https://doi.org/10.1007/s10461-011-9936-8
Mitchell, J. W., & Sophus, A. I. (2017). Perceptions and definitions of power within the context of HIV-negative male couples’ relationships. American Journal of Men’s Health, 11(4), 801–810. https://doi.org/10.1177/1557988315596038
Neilands, T. B., Dworkin, S. L., Chakravarty, D., Campbell, C. K., Wilson, P. A., Gomez, A. M., Grisham, K. K., & Hoff, C. C. (2019). Development and validation of the power imbalance in couples scale. Archives of Sexual Behavior, 48(3), 763–779. https://doi.org/10.1007/s10508-018-1190-y
Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis. International Journal of Qualitative Methods, 16. https://doi.org/10.1177/1609406917733847
Pal, K., Ngin, C., Tuot, S., Chhoun, P., Ly, C., Chhim, S., Luong, M. A., Tatomir, B., & Yi, S. (2016). Acceptability study on HIV self-testing among transgender women, men who have sex with men, and female entertainment workers in Cambodia: A qualitative analysis. PLoS ONE, 11(11), e0166129. https://doi.org/10.1371/journal.pone.0166129
Parsons, J. T., Severino, J., Nanin, J., Punzalan, J. C., von Sternberg, K., Missildine, W., & Frost, D. (2006). Positive, negative, unknown: Assumptions of HIV status among HIV-positive men who have sex with men. AIDS Education and Prevention, 18(2), 139–149. https://doi.org/10.1521/aeap.2006.18.2.139
Rael, C. T. (2021). Transgender women’s experiences using a dual HIV/Syphilis at-home rapid test to screen potential sexual partners. Manuscript submitted for publication.
Rosengren, A. L., Huang, E., Daniels, J., Young, S. D., Marlin, R. W., & Klausner, J. D. (2016). Feasibility of using GrindrTM to distribute HIV self-test kits to men who have sex with men in Los Angeles, California. Sexual Health, 13, 389–392. https://doi.org/10.1071/SH15236
Schnall, R., John, R. M., & Carballo-Dieguez, A. (2016). Do high-risk young adults use the HIV self-test appropriately? Observations from a Think-Aloud study. AIDS and Behavior, 20(4), 939–948. https://doi.org/10.1007/s10461-015-1240-6
Snowden, J. M., Raymond, H. F., & McFarland, W. (2009). Prevalence of seroadaptive behaviors of men who have sex with men, San Francisco, 2004. Sexually Transmitted Infections, 85(6), 469–476. https://doi.org/10.1136/sti.2009.036269
Thirumurthy, H., Masters, S. H., Mavedzenge, S. N., Maman, S., Omanga, E., & Agot, K. (2016). Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: A cohort study. The Lancet. HIV, 3(6), e266–e274. https://doi.org/10.1016/S2352-3018(16)00041-2
Volk, J. E., Lippman, S. A., Grinsztejn, B., Lama, J. R., Fernandes, N. M., Gonzales, P., Hessol, N. A., & Buchbinder, S. (2016). Acceptability and feasibility of HIV self-testing among men who have sex with men in Peru and Brazil. International Journal of STD & AIDS, 27(7), 531–536. https://doi.org/10.1177/0956462415586676
Wei, C., Raymond, H. F., Guadamuz, T. E., Stall, R., Colfax, G. N., Snowden, J. M., & McFarland, W. (2011). Racial/Ethnic differences in seroadaptive and serodisclosure behaviors among men who have sex with men. AIDS and Behavior, 15(1), 22–29. https://doi.org/10.1007/s10461-010-9683-2
Yan, H., Yang, H., Raymond, H. F., Li, J., Shi, L. E., Huan, X., & Wei, C. (2015). Experiences and correlates of HIV self-testing among men who have sex with men in Jiangsu province, China. AIDS and Behavior, 19(3), 485–491. https://doi.org/10.1007/s10461-014-0968-8
Acknowledgements
This research was supported by grants from the U.S. National Institutes of Health: R01-HD088156 (PI: I. Balán) and P30-MH43520 (PI: R. Remien). Dr. Christine Rael is supported by an NIMH K01 Award (MH115785) and Dr. Bryan Kutner is supported by an NIMH K23 Award (K23MH124569). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Cody Lentz, Javier Lopez-Rios, Curtis Dolezal, and Iván C. Balán. The first draft of the manuscript was written by Cody Lentz and all authors reviewed and provided significant intellectual contributions to the manuscript’s subsequent development. All authors have read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
Ethical Approval
This study was performed in line with the principles of the Declaration of Helsinki. All procedures were reviewed and approved by the New York State Psychiatric Institute’s Institutional Review Board.
Consent to Participate
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Lentz, C., Lopez-Rios, J., Dolezal, C. et al. Negotiating Use of a Blood-Based, Dual HIV and Syphilis Test with Potential Sexual Partners Among a Sample of Cisgender Men and Transgender Women Who Have Sex with Men in New York City. Arch Sex Behav 51, 2015–2025 (2022). https://doi.org/10.1007/s10508-021-02275-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-021-02275-3