There are significant concerns amongst gay men and gay venue owners about the provision of rapid HIV testing in locations such as pubs, clubs and saunas, according to a UK study published on January 17th in the online edition of Sexually Transmitted Infections.
Four areas of notable concern were identified by the investigators: confidentiality; the appropriateness of using ‘fun’ venues for such a serious health matter; the provision of support for individuals having a rapid HIV test; and, the potential impact on venues offering tests.
It is estimated that as many as a third of all HIV-positive individuals in the UK are unaware of their infection. Studies looking at HIV prevalence amongst gay men have found that over 40% of those with HIV infection leave sexual health services with their infection undiagnosed.
In the US rapid HIV, oral HIV testing for gay men in community and social settings has proved an acceptable way of improving HIV testing. As it is unknown how acceptable such an approach to testing in the UK would be, investigators conducted qualitative research involving a broad section of gay men and gay venue owners.
The confidentiality of individuals having an HIV test in social venues was identified as being essential. Respondents indicated that being seen to have an HIV test could be stigmatising as it may be seen to constitute an admission of risky sexual behaviour. Respondents were also concerned that individuals testing HIV-positive would find it difficult to leave the venue unnoticed if they were in a distressed state.
Pubs, clubs and saunas were also regarded as being inappropriate venues to deal with an event as serious as HIV testing. Most men regarded social venues as being ‘fun’ and therefore incompatible with serious health issues. There was also concern that men would not be in the ‘right frame of mind’ to deal with the potential consequences of a test.
Although syphilis and hepatitis B testing was offered by the NHS in some gay venues, there was a feeling that HIV testing was ‘different’ and ‘more serious.’ There were also concerns that hygiene would not meet required standards for HIV testing in venues where men engaged in sex.
Concerns about the feasibility of offering adequate post-test support were also voiced. Some participants also expressed concern that the receipt of an HIV test result would lead to inappropriate behaviour, with men testing negative seeking to ‘serosort’ whilst men testing positive may be tempted to indulge in self-destructive behaviours.
Venue owners were concerned that offering HIV tests might deter potential customers.
“This study has identified several substantial barriers to establishing rapid HIV testing services in venues such as bars, clubs and saunas”, conclude the investigators. They recommend that “future pilot studies of rapid HIV testing for gay men in social venues should build on qualitative research findings in order to develop appropriate service delivery models.”
Prost A et al. ”There is such a thing as asking for trouble”: Taking rapid HIV testing to gay venues is fraught with challenges. Sexually Transmitted Infections (online edition): January 17th, 2007.