Self‐testing, communication and information technology to promote HIV diagnosis among young gay and other men who have sex with men (MSM) in Brazil
Worldwide, key populations (KP), including gay and other men who have sex with men (MSM), are subject to human rights violations, criminalization, stigma and discrimination 1, 2. These socio‐structural factors are crucial to understand the low HIV testing uptake in many countries, as MSM may fear or may have experienced lack of privacy, confidentiality breaches and healthcare staff mistreatment 3. In Brazil, MSM report a low frequency of HIV testing despite higher estimated HIV prevalence (9.4% among 18 to 24 year olds; 19.8% among those 25 years and older 4), compared with 0.6% among the general population 5. HIV self‐testing (HIVST) is currently recommended by the World Health Organization to help reduce gaps in HIV diagnosis, especially for KP 6. Furthermore, HIVST has been highly accepted and accurate 7, 8, with oral tests being preferred over blood tests 9.
With the need to expand HIV diagnosis options for MSM, especially among young MSM, a committed team of governmental, research and non‐governmental organizations in Curitiba, Brazil launched and evaluated a multi‐component implementation science project from February 2015 to February 2017 to improve HIV outcomes for MSM. This project, called A Hora É Agora (The Time is Now) 10, implemented a multi‐pronged approach to increase HIV testing and linkage to care among MSM. The most innovative of the project's components was a web‐based platform and associated mobile application designed to provide HIV prevention information, allow for self‐assessment of risk, and deliver HIVST packages to eligible individuals (males, 18 years old and up, resident in Curitiba, with negative/unknown HIV status) upon request 11. Each HIVST package contained two oral‐fluid test kits, instructions for use and interpretation of HIVST results, a supply of condoms and lubricant, and information on confirmatory testing. Options for receiving the HIVST kits included either home delivery by mail or pick‐up at a government‐sponsored pharmacy.
A centerpiece of the project was a communications plan tailoring dynamic visuals with printed and virtual messaging to appeal to the target population; an attractive, online instructional video for HIVST users [https://www.ahoraeagora.org]; and frequent in‐person outreach events in places where MSM socialize in Curitiba. The project maximized the use of social media to reach out to and to engage young men in HIVST. Facebook and gay online sites such as ManHunt and Grindr played a key role in disseminating HIV testing messages. Mobile tools, such as WhatsApp and other freeware instant messaging applications boosted communications between users and project staff, including health system navigators for linkage to care. Working to ensure outreach to these groups, organizations involved in project implementation partnered with gay and MSM‐friendly establishments such as saunas, movie theatres, cafes, and bars to further disseminate HIVST information.