South Africa: Give HIV home-test kits to men who have sex with men, say researchers

Giving men who have sex with men (MSM) access to free self-screening HIV kits would increase testing among hard-to-reach groups and help South Africa reach its HIV targets. This is according to a new study published in the South African Medical Journal (SAMJ).

The study was done with MSM in the high HIV-prevalence districts of Gert Sibande and Ehlanzeni in Mpumalanga. 127 people were provided with their choice of blood or oral fluid self-screening HIV testing kits. Some 114 responded to follow-up interviews, three months and six months after receiving the tests. 49% said they would prefer to obtain the kits from community organisations; 43% from a clinic; and 8% from a pharmacy. The majority could not afford to buy the kits.

“Although the healthcare system in South Africa can be accessed through local clinics, clinic-based testing is often impractical for MSM, who face barriers and stigma related to public health services owing to their sexual orientation,” according to the study.

The government needs to consider other ways of getting people tested, for example via community based organisations or peer groups, wrote the researchers. They recommend that free or low cost self-testing HIV kits should be made available to MSM through community based initiatives.

According to the researchers no social harms were observed during the study. However, Dr Peter Barron, a public health expert, sounded a note of caution when talking to GroundUp. It’s a new intervention and needs more “rigorous checks and balances including whether it is cost-effective” he said.

“What will the full cost of the programme involved in the distribution of the HIV self-testing kits be, and how many new cases will be diagnosed? Without more work on this — with some decent data — it is premature to say it should be taken to scale; especially if funded by the state where there are multiple competing priorities. Health technology assessments where interventions are ranked, prioritised and compared is the best way to get value for money,” said Barron. Read more via Ground UP

RADEBE, O et al. HIV self-screening distribution preferences and experiences among men who have sex with men in Mpumalanga Province: Informing policy for South Africa. South African Medical Journal, [S.l.], v. 109, n. 4, p. 227-231, mar. 2019. ISSN 2078-5135. Available at <>.

Current research suggests that HIV self-screening (HIVSS) is a feasible and acceptable approach to increase HIV testing among men who have sex with men (MSM). However, few data are available to shape policy around dissemination and implementation. Gaps in knowledge include preferences for distribution of HIVSS kits, potential social harms and benefits of their use, and how much test users would be willing to pay for the kits. The aim was to inform policy recommendations to optimise distribution of HIVSS kits to MSM in South Africa (SA), where there is a high HIV incidence and unmet testing needs. MSM in the high-HIV-prevalence Gert Sibande and Ehlanzeni districts of Mpumalanga Province, SA, were enrolled between October 2015 and May 2017. Participants were provided with their choice of blood or oral fluid HIVSS test kits, receiving 5 kits at enrolment and 4 additional kits at the 3-month follow-up visit. Questionnaires were administered at enrolment, 3 months and 6 months. We analysed participants’ reported social benefits and harms, and their preferences for kit distribution and pricing. Among 127 MSM screened and enrolled, 114 responded to follow-up questionnaires regarding distribution preferences, 49.3% preferred to acquire HIVSS kits at a community-based organisation (CBO) and 42.7% at a clinic, with 8% preferring a pharmacy. Participants with higher education preferred CBO sites for distribution; in other respects preferences were similar by demographic characteristics. Reported social benefits were common, including knowing one’s status, prevention knowledge gained and improved communication with partners. Despite ubiquitous interest in using the kits, the majority of MSM could not afford to purchase test kits. SA guidelines have integrated HIVSS into HIV and testing policy, but little has been published regarding distribution channels of the kits for MSM and other key populations. There is a partnership between the National Department of Health and CBOs that specialise in key population programming to ensure MSM and other populations with unmet testing needs can access affordable test kits. We observed no social harms, and there were multiple social benefits. Consequently, we recommend immediate free or low-cost distribution of HIVSS kits to MSM through community-based initiatives. Future research should continue to assess optimised linkage to care.