Couples-based HIV testing acceptable to MSM in Cape Town

Couples-based HIV counselling and testing would be welcomed by gay and other men who have sex with men (MSM) in Cape Town, according to an article published in AIDS and Behavior.

Investigators used focus groups and in-depth individual interviews to gauge attitudes towards couples-based voluntary HIV counselling and testing (CVCT). “The results show an overwhelmingly high acceptance for CVCT services catered towards MSM among MSM,” comment the authors. “The additive support and commitment gained from testing for HIV with a partner was the main draw for using CVCT services, allowing for a couple to disclose personal information and sexual behaviors with each other, and in the presence of a trained counselor, work through these situations and strengthen their relationship.”

The main barrier to using the service was the fear of being diagnosed with HIV. “However, this deterrent could be surmounted if MSM could take their supportive partners with them to test.”

Testing is a cornerstone of HIV prevention. Couples-based testing of heterosexual couples has been used in Africa for over 20 years. The strategy has been described as a “high leverage HIV prevention intervention.” Couples-based counselling and testing typically involves four steps:

• Provision of pre-test information.
• Pre-test counselling and risk assessment.
• Test results.
• Post-test counselling.

Studies involving serodiscordant heterosexual couples have shown that couples testing is effective at reducing sexual risk-taking and HIV transmission.

HIV prevalence among gay and other MSM in most sub-Saharan countries equals or exceeds that seen in the heterosexual population. Research conducted in industrialised countries suggests that many gay men are infected with HIV within the context of relationships. Given the success of couples-based testing in heterosexual populations, investigators in Cape Town wished to see if this strategy would be acceptable to gay and other MSM.

They therefore designed a study involving 71 MSM who were recruited via gay community organisations. In seven structured focus groups, the men explored their thoughts and feelings about couples-based HIV testing, discussing the perceived benefits and drawbacks of this intervention. These issues were further explored with 29 individuals in one-to-one interviews.

The study was conducted between July 2010 and January 2011. Participants had a median age of 28 years. Just over half (52%) were black. Almost three-quarters (72%) reported being in a sexual relationship, with 54% of individuals saying they had a main partner.

Participants were initially reluctant to support couples testing. However, there was a significant change in attitudes after the steps involved in testing were outlined and explained.

The participants especially welcomed the transparency provided by joint testing. There was also a belief that testing together would facilitate open conversations concerning issues such as sex outside the relationship.

Some men reported that they had been denied access to joint testing with their partner. This was perceived as an equality issue.

There was a consensus among participants that gay couples would come forward for joint testing. Couples who were “building a future”, “exclusive”, “living together”, “had nothing to hide” and “committed to each other” were thought especially likely to test. Several men believed that joint testing would be of benefit to new couples before they commenced a sexual relationship.

However, couples where one or both partners were also in a relationship with a woman were thought unlikely to use the service.

The need for testing counsellors who were sensitive to MSM relationships was stressed by a number of participants, and there was a consensus that joint testing should be offered by organisations with a reputation for being “gay friendly”.

The main perceived barriers to the use of joint testing were the cost of travelling to the testing facility and the fear of an HIV diagnosis.

There was a consensus that concordant test results would strengthen bonds within a relationship. There was a perception that a discordant result could, in some circumstances, threaten a relationship. This was especially the case if a partner was blamed for being “unfaithful”.

“The data presented here exhibits compellingly high acceptance of CVCT among this sample of MSM from Cape Town,” conclude the investigators, who believe their study “provides promise for the potential for CVCT to be accepted widely among the MSM population in South Africa”.

Stephenson R et al. Attitudes toward couples-based HIV counseling and testing among MSM in Cape Town, South Africa. AIDS Behav, online edition. DOI 10. 1007/s10461-012-0293-z, 2012.