Young, Online and in the Dark: Scaling Up HIV Testing among MSM in ASEAN

<div><p>Background</p><p>Poor HIV testing uptake by MSM may be attributable to unique challenges that are localized in Southeast Asia.</p><p>Objective</p><p>To characterize MSM who never tested for HIV, to identify correlates of never testing, and to elucidate the perceived barriers to HIV testing.</p><p>Methods</p><p>The present study used data from the Asian Internet MSM Sex Survey (AIMSS) and restricted the analysis to 4,310 MSM from the ten member countries of the Association of South East Asian Nations (ASEAN).</p><p>Results</p><p>Among MSM participants from ASEAN in our sample, 1290 (29.9%) reported having never been tested for HIV, 471 (10.9%) tested for HIV more than 2 years ago, and 2186 (50.7%) reported their last test date was between 6 months and two years ago, with only 363 (8.4%) of these men having been tested in the past 6 months. In multivariable logistic regression, younger MSM (age 15–22 years old [AOR: 4.60, 95% CI: 3.04–6.96]), MSM with lower education (secondary school or lower [AOR: 1.37, 95% CI: 1.03–1.83]), MSM who identify as bisexual or heterosexual (compared to gay-identified) (AOR: 1.94, 95% CI: 1.60–2.35), and MSM who had never used a condom with male partners (AOR: 1.61, 95% CI: 1.32–1.97) had higher odds of never been HIV tested. Main reason for not being tested was a low risk perception of HIV exposure (n = 390, 30.2%).</p><p>Conclusion</p><p>Current HIV prevention response must not leave MSM “in the dark,” but instead meet them where they are by utilizing the Internet creatively through social media and smart phones. As ASEAN Economic Community (AEC) is quickly becoming a reality, so must there be an equally fast and united response to slowing down the HIV epidemics among MSM in ASEAN.</p></div

Factors associated with never tested for HIV among an online sample of 4,310 men who have sex with men (MSM) from ASEAN countries.

<p>^aCollapsed with bisexual identity for subsequent analysis</p><p>^bSum not equal to total sample size due to missing responses</p><p>Factors associated with never tested for HIV among an online sample of 4,310 men who have sex with men (MSM) from ASEAN countries.</p

Independent correlates of never tested for HIV among an online sample of men who have sex with men (MSM) from ASEAN countries (N = 3632)^a.

<p>^aThe model also adjusted for educational status and no. of male sexual partners in the past 6 moths.</p><p>Likelihood Ratio test: X² = 510.1, df = 23, p<0.001</p><p>Max-rescaled (pseudo) R-Square = 0.188</p><p>Goodness-of-fit test: X² = 5.65, df = 8, p = 0.687</p><p>Independent correlates of never tested for HIV among an online sample of men who have sex with men (MSM) from ASEAN countries (N = 3632)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0126658#t002fn001" target="_blank">^a</a>.</p

Demographic characteristics, knowledge of malaria, ownership and use of insecticide-treated nets (ITNs) by households in urban vs. rural areas in eastern Myanmar, 2014 (N = 4,679 households).

<p>Demographic characteristics, knowledge of malaria, ownership and use of insecticide-treated nets (ITNs) by households in urban vs. rural areas in eastern Myanmar, 2014 (N = 4,679 households).</p

Characteristics of households in which all children under 5 years old slept under an effective insecticide-treated net (ITN), eastern Myanmar, 2014 (N = 1,636).

<p>Characteristics of households in which all children under 5 years old slept under an effective insecticide-treated net (ITN), eastern Myanmar, 2014 (N = 1,636).</p

Reasons for never tested for HIV among an online sample of men who have sex with men (MSM) who never tested for HIV (N = 1290).

<p>Reasons for never tested for HIV among an online sample of men who have sex with men (MSM) who never tested for HIV (N = 1290).</p

HIV prevalence among MSMW, compared to MSWE, U.S.

<p>HIV prevalence among MSMW, compared to MSWE, U.S.</p

STI and sexual risk behavior differences between MSMW, MSMO, and MSWE.

*<p>All studies included measured any STI rather than individual kinds of STI, except one <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0087139#pone.0087139-Levin1" target="_blank">[42]</a>: for this study, we used data only on human papillomavirus symptoms/diagnosis in these analyses.</p

Flow diagram of included and excluded records.

<p>Flow diagram of included and excluded records.</p

HIV prevalence among MSMW, compared to MSMO, U.S.

<p>HIV prevalence among MSMW, compared to MSMO, U.S.</p