HIV Point of Care Testing (PoCT) at Late-Night Sex on Premises Venues (SOPV) for Gay and Bisexual Men and Other Men Who Have Sex with Men (GBMSM): A Mixed Methods Analysis

Abstract

The aim of this study was to establish ‘proof of concept’ for a novel approach to HIV and STI testing at a sex on premises venue (SOPV) for gay and bisexual and other men who have sex with men (GBMSM) during late night group sex theme parties. A mixed-methods approach was used, and the study aimed to: (1) Build upon existing SOPV funded service delivery and establish ‘proof of concept’ for this unique setting within an SOPV; (2) evaluate the uptake and feasibility/acceptability of routine HIV/STI testing for GBMSM during theme parties in SOPV; and (3) identify beliefs/perceptions regarding this health promotion activity and venue suitability. The characteristics of patrons utilising PoCT (Point of Care Testing) were established to help further reach potentially stigmatised, highly sexually adventurous GBMSM. The findings support further PoCT endeavours within MSM communities to target harder to reach communities to reduce the rate of new transmissions of HIV. Findings can inform future health promotion, screening and interventions, as well as to identify a successful method to engage harder to reach GBMSM that need further focused targeting for HIV and STI testing to reduce transmission.

Appendices

Appendix 1: Patrons

“Thank you for agreeing to participate in this anonymous and confidential phone interview today. I am going to ask you a range of questions regarding your recent testing experience at RAPID (venue name) and other factors associated with the testing environment and the club. Please feel free to decline answering any questions you may not feel comfortable with and asking me any questions as we go along.”

Testing/experience

• 1. Can you tell me a little bit about your recent RAPID testing experience at (venue name)? (start open ended); and ask and note about additional follow up prompts: staffing, environment, privacy, accessibility

  What did you like about the testing experience; What did you not like so much?

  What motivated you get tested at (venue name)? (or why did you choose to get tested there?)

Acceptability/feasibility

• 1. Some people find it hard to go and have an HIV test (for a variety of reasons)…Do you think there are any barriers to testing at (venue name)? (provide additional prompts if needed; e.g., uncomfortable talking with GP about sex, or it’s too expensive, or they just can’t seem to find the time.)

• 2. Are there barriers to testing at other venues (e.g., GP, sexual health clinic; where?/what barriers)? (provide additional prompts if needed; e.g., uncomfortable talking with GP about sex, or it’s too expensive, or they just can’t seem to find the time.)

  If any, can you please describe?;

• 3. As you are aware RAPID provides testing for HIV and other STI’s at various sites, including outreach setting. Can I ask you which tests you have had at (venue name)?

• 4. What are the factors (if any) that make it easy or more comfortable for you to get tested for HIV or other STI’s at (venue name)?

• 5. How does your recent experience at (venue name) differ from your other testing experiences (if you have had other testing experiences)? Was it easier/harder; how so (please describe)?

• 6. It’s generally considered a good idea for people to test regularly for HIV and other STI’s, so as to stay in control of their health and avoid passing things on to other people. Do you think availability of testing at a place like (venue name) would increase how often you would test? (how so?/why?) Is there another place that you’d prefer to get a test? (where?; why?)

• 7. Is there anything that would make you more likely to get tested or continue to get tested regularly for HIV and STI’s? (if so, what?; please describe)

Now, I am going to ask some questions in relation to your experiences at (venue name) and similar venues…

Venue environment (and motivations for attending sexual environment):

• 1. What are the things you like about going to (venue name)?

  From talking to other guys who go there, they go to just get ‘a bit of action’ after they’ve been out for dinner with friends and they’re wanting sex/horny—but at the same time, a lot of guys say they would really like to meet someone and have a great physical connection at the venue. Do you relate to any of these reasons or other ones for visiting the club?

  Why do you think other people visit the club (are there other reasons)? Do you feel like you can relate to their experiences? Do you feel like you have things in common with those people? (may lead to honest responses of how they compartmentalise, stereotype and justify their and others rationale for attending).

• 2. Do you use alcohol or other party drugs at a (venue name) (or other similar venues)? If so, what do you use? (start open-ended then list specific drugs Y/N: alcohol, crystal/meth, amyl, speed, Ecstasy, GHB, ketamine, cannabis, Viagra, others)

  If, so what might you use on a typical night? (before/during/after party; record details)

• 3. How do these drugs transform (enhance or limit): (discuss in general, and also seek information specific to separate drugs typically used; and any comments in relation to substance use in combination);

  • a. Your desire or willingness to attend the venue?

  • b. Your experiences at the venue:

    • i. Socially (for example, do you feel like you can talk to people more easily)?

    • ii. Sexual experiences, do you feel increased gratification or a higher level of satisfaction or disinhibition?

  • c. The types of sex you have? (for example, anal sex without condoms)?

  • d. Do you have any other comments on how specific drugs transform your:

    • i. Thoughts?

    • ii. Feelings?

    • iii. Behaviours (including sexual behaviour)?

    • iv. Connection with others (emotionally, sexually)?

    • v. Disinhibition?

• 4. How are your experiences with alcohol/other party drugs and sex similar or different at (venue name or similar venues) than in other environments…such as when you’re just at home or at ‘beats’? (if so, how?, which drugs?; Note to interviewer: Discussions could generally explore some of the themes if noted among participant: Permissions, expectations and initiations associated with each substance, and how an individual negotiates use in different setting)

  Do you attend venues specifically to engage in ‘chemsex’? (if so, please describe)

• 5. Are there any strategies you use to reduce harms or risks (and promote resiliency) whilst at the venues in relation to:

  • a. Alcohol and other party drugs?

  • b. Sex?

  • c. Both substance use and sex?

  • d. Do you use PreP, if so, please describe what context and if in conjunction with substance use and/or at (venue name or similar venues)

  • e. Do you use other strategies to reduce risk of HIV or STI’s (such as condoms or any other strategies), if so, please describe what context and if in conjunction with substance use and/or at (venue name or similar venues)

• 6. Do you have any suggestions regarding ways to reduce harms or risks at the venues re: alcohol or other drug use and/or sex?

• 7. Now I am going to ask you some general questions regarding you and your background, so that we are able to describe the entire group of people we have interviewed, in a non-identified way; if you feel comfortable answering.

• 8. Do you have any other thoughts you would like to add in relation to any of the questions or topics discussed?

Appendix 2: Peer-testers

“Thank you for agreeing to participate in this anonymous and confidential phone interview today. I am going to ask you a range of questions regarding your perceptions as a peer-tester of patrons’ testing experience at RAPID (venue name) and other factors associated with the testing environment and the club. Please feel free to decline answering any questions you may not feel comfortable with and asking me any questions as we go along.”

Testing/experience:

• 1. Can you tell me a little bit about your perceptions regarding patrons RAPID testing experience at (venue name)? (start open ended); and ask and note about additional follow up prompts: staffing, environment, privacy, accessibility

  What did patrons report that they liked about the testing experience; What did they report to not like so much?

  What did patrons report motivated them get tested at (venue name)?

Acceptability/feasibility

• 1. Some people find it hard to go and have an HIV test (for a variety of reasons)…Do you think there are any barriers to patrons/MSM testing at (venue name)? (provide additional prompts if needed; e.g., uncomfortable talking with GP about sex, or it’s too expensive, or they just can’t seem to find the time.)

• 2. Based on reports from patrons, are there barriers to testing at other venues (e.g., GP, sexual health clinic; where?/what barriers)? (provide additional prompts if needed; e.g., uncomfortable talking with GP about sex, or it’s too expensive, or they just can’t seem to find the time.)

  If any, can you please describe?;

• 3. As you are aware RAPID provides testing for HIV and other STI’s at various sites, including outreach setting. Which tests did were most commonly requested at (venue name)?

• 4. What are the factors (if any) that make it easy or more comfortable for patrons to get tested for HIV or other STI’s at (venue name), based on their reports?

• 5. Did clients report if their recent experience at (venue name) differed from their other testing experiences (if they reported to have had other testing experiences, If yes, how so?)? Was it easier/harder; how so (please describe)?

• 6. It’s generally considered a good idea for people to test regularly for HIV and other STI’s, so as to stay in control of their health and avoid passing things on to other people. Based on reports from patrons’, do you think availability of testing at a place like (venue name) would increase how often MSM patrons would test? (how so?/why?) Is there another place that they’d prefer to get a test? (where?; why?)

• 7. Based on patron reports, is there anything that would make MSM attending SOPVs more likely to get tested or continue to get tested regularly for HIV and STI’s? (if so, what?; please describe)

“Now, I am going to ask some questions in relation to your perceptions of experiences at (venue name) and similar venues, based on their reports…”

Venue environment (and motivations for attending sexual environment):

• 1. What are the things they like about going to (venue name)?

  From talking to other guys who go there, they go to just get ‘a bit of action’ after they’ve been out for dinner with friends and they’re wanting sex/horny—but at the same time, a lot of guys say they would really like to meet someone and have a great physical connection at the venue. Have patrons reported to you any of these reasons or other ones for visiting the club?

• 2. Do you observe patrons using alcohol or other party drugs at a (venue name or appear to be under the influence of substances?)? If so, what substance use has been observed or reported? (start open-ended then list specific drugs Y/N: alcohol, crystal/meth, amyl, speed, Ecstasy, GHB, ketamine, cannabis, Viagra, others)

• 3. What are your perceptions as a peer-tester regarding how these drugs transform (enhance or limit): (discuss in general, and also seek information specific to separate drugs typically used; and any comments in relation to substance use in combination)—based on your role in the health promotion project and patron reports;

  • a. MSM desire or willingness to attend the venue?

  • b. MSM experiences at the venue:

    • i. Socially

    • ii. Sexual experiences

  • c. The types of sex patrons report (in pre-testing discussions)? (for example, anal sex without condoms)?

  • d. Do you have any other comments on how specific drugs transform experiences among MSM at the SOPV, as reported by clients?

    • i. Thoughts?

    • ii. Feelings?

    • iii. Behaviours (including sexual behaviour)?

    • iv. Connection with others (emotionally, sexually)?

    • v. Disinhibition?

• 4. Do you have any suggestions regarding ways to reduce harms or risks at the venues re: alcohol or other drug use and/or sex?

  • e. Alcohol and other party drugs?

  • f. Sex?

  • g. Both substance use and sex?

  • h. How frequently to patrons report use of PreP, if they have, please describe what contexts and if in conjunction with substance use and/or at (venue name or similar venues)

  • i. Do patrons report any other strategies to reduce risk of HIV or STI’s (such as condoms or any other strategies), if so, please describe what context and if in conjunction with substance use and/or at (venue name or similar venues)

• 5. Are there any strategies patrons report to reduce harms or risks (and promote resiliency) whilst at the venues in relation to:

• 6. Now I am going to ask you some general questions regarding you and your background, so that we are able to describe the entire group of people we have interviewed, in a non-identified way; if you feel comfortable answering.

• 7. Do you have any other thoughts you would like to add in relation to any of the questions or topics discussed?

Length of time assisting on the project:

Number of shifts as a peer-tester:

Length of time at RAPID as a peer-tester:

Appendix 3

Country of birth list (other)

Country, N = 62	n (%)
Bosnia	2 (1.0%)
Brazil	5 (2.4%)
China	7 (3.4%)
Croatia	1 (0.5%)
El Salvador	3 (1.4%)
England	1 (0.5%)
Fiji	5 (2.4%)
France	1 (0.5%)
Germany	1 (0.5%)
Hong Kong	1 (0.5%)
India	4 (1.9%)
Japan	1 (0.5%)
Kiribati	1 (0.5%)
Korea	1 (0.5%)
Malaysia	3 (1.4%)
Peru	1 (0.5%)
Philippines	5 (2.4%)
Papua New Guinea	3 (1.4%)
Samoa	1 (0.5%)
Scotland	1 (0.5%)
Singapore	4 (1.9%)
Slovakia	1 (0.5%)
Sri Lanka	1 (0.5%)
United Kingdom	4 (1.9%)
United States of America	1 (0.5%)
Venezuela	1 (0.5%)
Vietnam	1 (0.5%)
Zimbabwe	1 (0.5%)