Three quarters of those using England’s free self-sampling
service are men who have sex with men, with the service particularly popular among
younger men and men who have not recently tested, Luis Guerra of Public Health
England told a Public Health England seminar last week.
While the service is marketed to both men who have sex with
men (MSM) and black African communities, only 7% of those testing belong to the
latter group. A separate pilot study conducted with black African communities highlighted
some barriers to the uptake of self-sampling in its current form.
The significant number of people living with HIV without
being aware of their infection is one of the most persistent challenges to HIV
prevention in the UK. Public health researchers and agencies are interested in
the potential of new HIV testing technologies and innovative models of service
delivery to encourage people to test more frequently.
Some services offer self-testing, in which the user collects
a sample and performs the whole test themselves, including reading the result.
However, the programmes described here are self-sampling, in which the user
collects a fingerprick blood sample and sends this off to a laboratory for
analysis. Results are communicated by phone or text message a few days later.
Following a series of pilot projects, Public Health England
(PHE) launched an HIV self-sampling service one year ago. However it has not
been consistently available in all parts of the country – sometimes
commissioned by PHE on a national basis, at other times only available to
people living in the 54% of local authorities who have commissioned it for
their residents. (For the next two months, it will again be available
nationwide, to coincide with National HIV Testing Week and World AIDS Day).
Promotion and ordering of self-sampling kits is done online
well as their postcode, users need to provide some information about their
ethnicity and sexual behaviour in order to check whether they are eligible for
the service. While the service is promoted to gay men and black African
communities, it is available to other people at high risk of HIV.
Data were presented on users from November 2015 to September
2016. A total of 35,647 tests were ordered, with 52% of them returned. As with
other self-sampling and self-testing projects, the number of orders is highly
responsive to marketing and promotional activities, such as during National HIV
Whereas one third of users had tested in the previous year,
one third had tested more than a year ago, and one third had never tested for
In terms of demographics, 75% of people testing were gay
men, 13% were heterosexual women and 10% heterosexual men. The service was also
used by lesbian and bisexual women (1.7%) and trans people (0.6%).
Amongst the heterosexual men and women, 30% were of black
African ethnicity. A further 20% belonged to other ethnic minority groups.
Two-thirds of all users were under the age of 30, but they
were not the most likely to have a reactive result.
Overall, 195 of 18,270 tests (1.1%) were reactive (in other
words, possibly HIV-positive, but needing additional tests for confirmation).
Reactive results are especially likely to be seen in some
groups of users: 2.3% in people aged 41-45 (and generally higher in older than
in younger people), 1.6% in black African heterosexuals, 2.6% in black African
MSM (and generally higher in ethnic minority MSM than in white MSM), and 3.0%
in trans people.