Table 1 shows descriptive results according to no previous HIV test and a previous negative HIV result. The following characteristics did not differ according to the two strata: MSM under 25 years of age (64.3% and 59.5%, respectively), brown/mixed race (48.4% and 39.2%, respectively), single, separated/widowed (90.1% and 86.1%, respectively), and reporting protective sex (66.8% and 61.3%, respectively) (p > 0.05). MSM with no previous HIV test compared to MSM who had a previous negative HIV result, had less schooling (46.1% vs 23.5%, p < 0.001), lower socio-economic status (26.5% vs 9.7%, p < 0.001), reported less experience of discrimination during the lifetime (53.1% vs 71.5%, p < 0.001) and had lower HIV risk perception (24.9% vs 14.6%, p < 0.01). In terms of health services, the majority of MSM did not engage in workshops on STI and HIV/AIDS in the last 12 months in both groups (83.0% and 79.0%, respectively, p > 0.05). On the other hand, those with no previous HIV test compared to MSM who had a previous negative HIV result, reported less medical appointment in the last 12 months (69.6% vs 87.1%, p < 0.001), lower knowledge about HIV/AIDS (35.4% vs 24.0%, p < 0.001) and took part less of LGBT NGO (12.1% vs 19.9%, p = 0.03).
Table 1. Descriptive analysis of MSM according to no previous HIV test and a previous negative HIV result Brazil, 2016.
Variables
|
No previous HIV test¹
|
Previous negative HIV result¹
|
p-value
|
%
|
95%CI
|
%
|
95%CI
|
Age
|
|
|
0.26
|
< 25 years old
|
64.3
|
(57.2-70.9)
|
59.5
|
(54.8-64.1)
|
≥ 25 years old
|
35.7
|
(29.1-42.8)
|
40.5
|
(35.9-45.2)
|
Race
|
|
|
0.09
|
Brown/mixed race
|
48.4
|
(41.6-55.2)
|
39.2
|
(34.7-43.9)
|
White
|
29.1
|
(22.9-36.2)
|
34.9
|
(30.5-39.5)
|
Black
|
22.5
|
(17.9-27.9)
|
25.9
|
(21.4-31.2)
|
Schooling
|
|
|
<0.001
|
Primary/Incomplete secondary education
|
46.1
|
(39.6-52.6)
|
23.5
|
(19.9-27.5)
|
Complete secondary/Incomplete undergraduate education
|
48.8
|
(42.4-55.2)
|
62.6
|
(58.1-67.0)
|
Complete undergraduate education
|
5.2
|
(2.3-11.5)
|
13.9
|
(11.3-17.1)
|
Socio-economic status groups
|
|
|
<0.001
|
D-E (Low)
|
26.5
|
(21.0-32.8)
|
9.7
|
(7.5-12.4)
|
C (Middle)
|
38.5
|
(32.3-45.0)
|
42.1
|
(37.4-46.9)
|
A-B (High)
|
35.1
|
(29.1-41.6)
|
48.2
|
(43.5-53.0)
|
Marital status
|
|
|
0.10
|
Single/separated/widowed
|
90.1
|
(85.9-93.2)
|
86.1
|
(82.9-88.8)
|
Married/living together
|
9.9
|
(6.8-14.1)
|
13.9
|
(11.2-17.1)
|
Self-reported discrimination during the lifetime
|
|
|
<0.001
|
No
|
46.9
|
(40.5-53.5)
|
28.5
|
(24.7-32.7)
|
Yes
|
53.1
|
(46.5-59.5)
|
71.5
|
(67.3-75.3)
|
Medical appointment in the last 12 months
|
|
|
<0.001
|
No
|
30.4
|
(25.0-36.4)
|
12.9
|
(10.2-16.1)
|
Yes
|
69.6
|
(63.6-75.0)
|
87.1
|
(83.8-89.7)
|
Took part of any workshop on STI and HIV/AIDS in the last 12 months
|
|
|
0.26
|
No
|
83.0
|
(76.7-87.9)
|
79.0
|
(74.8-82.7)
|
Yes
|
17.0
|
(12.1-23.3)
|
21.0
|
(17.3-25.2)
|
Knowledge about HIV/AIDS (IRT score)2
|
|
|
<0.001
|
Low
|
35.4
|
(29.4-41.9)
|
24.0
|
(19.6-29.1)
|
Middle
|
47.6
|
(41.0-54.2)
|
47.0
|
(42.3-51.8)
|
High
|
17.1
|
(12.7-22.6)
|
29.0
|
(25.0-33.3)
|
Perception of risk
|
|
|
|
|
|
|
<0.01
|
Low
|
24.9
|
(19.6-31.0)
|
14.6
|
(11.6-18.4)
|
Middle
|
60.8
|
(54.1-67.8)
|
74.8
|
(70.2-79.0)
|
High
|
14.2
|
(9.4-20.9)
|
10.5
|
(7.7-14.1)
|
Took part of LGBT NGO
|
|
|
0.03
|
No
|
87.9
|
(81.7-92.2)
|
80.1
|
(76.2-83.6)
|
Yes
|
12.1
|
(7.8-18.3)
|
19.9
|
(16.5-23.8)
|
Condomless receptive anal sex (past 6 months)
|
|
|
0.15
|
Always used condoms
|
66.8
|
(60.5-72.4)
|
61.3
|
(56.8-65.6)
|
Irregular use of condoms
|
33.3
|
(27.6-39.5)
|
38.7
|
(34.4-43.2)
|
1 Weighted by Gile-SS.
Overall HIVST acceptability was 47.3% (95% CI: 43.5, 51.1) and overall reasons for its use were: curiosity (31.3%), as a routine test (27.8%), practicality (17.8%), believe to be at risk for HIV infection (16.6%), and confidentiality (11.3%). And reasons for not using it were: fear (42.7%), did not see why to use it (23.8%), unaware of test availability (2.3%), believe to be at low or no risk for HIV infection (1.8%) and because it has never been offered (1.6%) (Table 2).
Table 2. Acceptability of HIVST and reasons for use/non-use among MSM according to no previous HIV test and a previous HIV negative result in 12 Brazilian cities, 2016.Variables | Overall¹ | No previous HIV test¹ | Previous negative HIV result¹ | p-value* |
% | 95%CI | %² | 95%CI | % | 95%CI |
Acceptability of HIVST |
| | |
|
| |
|
|
| 0.07 |
Yes | 47.3 | (43.5-51.1) | 42.7 | (36.3-49.3) | 50.1 | (45.3-54.9) |
No | 52.7 | (48.9-56.5) | 57.3 | (50.7-63.7) | 49.9 | (45.1-54.7) |
Reasons to use HIVST |
| | |
|
| |
|
|
| |
Curiosity | 31.3 | (26.7-36.4) | 36.8 | (27.1-47.7) | 28.6 | (24.0-33.7) | 0.14 |
As a routine test | 27.8 | (24.2-31.7) | 25.8 | (19.2-33.8) | 28.8 | (24.7-33.4) | 0.50 |
It is more practical | 17.8 | (13.6-22.8) | 10.7 | (6.3-17.5) | 21.4 | (15.9-28.1) | 0.01 |
Believes to be at risk for HIV infection | 16.6 | (13.5-20.4) | 16.8 | (11.0-24.8) | 16.6 | (13.1-20.8) | 0.95 |
Confidentiality | 11.3 | (8.5-14.9) | 8.9 | (6.1-12.8) | 12.6 | (8.8-17.6) | 0.18 |
Reasons to not use HIVST | | | | | | | |
|
| |
Fear | 42.7 | (37.2-48.3) | 50.0 | (41.8-58.3) | 37.8 | (30.8-45.3) | 0.03 |
Does not see any reason to use it | 23.8 | (20.0-27.9) | 24.6 | (19.0-31.2) | 23.2 | (18.3-28.9) | 0.73 |
Unaware of test availability | 2.3 | (1.6-3.3) | 2.5 | (1.5-4.4) | 2.1 | (1.2-3.5) | 0.62 |
Believe to be at low or no risk for HIV infection | 1.8 | (1.0-3.0) | 1.1 | (0.5-2.3) | 2.2 | (1.1-4.4) | 0.14 |
Because it has never been offered | 1.6 | (1.0-2.6) | 1.2 | (0.6-2.4) | 1.8 | (1.0-3.4) | 0.39 |
¹ Weighted proportion by Gile-SS;
* p-value refers to the comparison of proportions between: “no previous HIV test” and “negative previous HIV result”.
HIVST acceptability was higher among those who had a previous negative HIV result (50.1%; 95% CI: 45.3, 54.9), as compare to those with no previous HIV test (42.7%; 95% CI: 36.3, 49.3), but this did not reach statistically significant level (p=0.07). Regarding reasons for its use, only practicality of the test (10.7% vs 21.4%, p = 0.01) and fear (50.0% vs 37.8%, p = 0.03) were statistically significant different comparing the two strata (Table 2).
Table 3 shows the bivariate and multivariate analyses also stratified by testing history. In the multivariate analysis, among MSM with no previous HIV test, experience of discrimination (AOR = 2.00, 95%CI: 1.18, 3.38) and a medical appointment in the last 12 months (AOR = 1.74, 95%CI: 1.01, 2.99) had a higher odds of HIVST acceptability. Among MSM who had a previous HIV negative test, condomless receptive anal sex (AOR = 1.46, 95%CI: 1.00, 2.15) had greater odds of HIVST acceptability. In addition, in both strata, we observed that high levels of HIV/AIDS knowledge (AOR = 2.45, 95%CI: 1.05, 5.70 and AOR = 2.79, 95%CI: 1.58, 4.93), belonging to an LGBT NGO (AOR = 3.26, 95%CI: 1.29, 8.25 and AOR = 2.06, 95%CI: 1.28, 3.32), and complete secondary or incomplete undergraduate school (AOR = 1.74, 95%CI: 1.01, 3.01 and AOR = 2.17, 95%CI: 1.34, 3.51) were associated with greater odds of HIVST acceptability.
Table 3. Acceptability of HIVST among an RDS sample of MSM. stratified by the report of prior HIV testing in 12 Brazilian cities. 2016.
Variables
|
No previous HIV test
|
Previous negative HIV result
|
|
Bivariate
|
Multivariate
|
Bivariate
|
Multivariate
|
|
Wt%1
|
Unadj OR2
|
p-value
|
AdjOR3
|
p-value
|
Wt%1
|
Unadj OR2
|
p-value
|
AdjOR3
|
p-value
|
|
Age
|
|
|
|
>=25 years
|
34.2
|
1.00
|
0.07
|
|
|
48.3
|
1.00
|
0.53
|
|
< 25 years
|
48.3
|
1.79 (0.93-3.45)
|
|
-
|
-
|
51.4
|
1.13 (0.76-1.66)
|
|
-
|
-
|
|
Race
|
|
Black
|
34.6
|
1.00
|
0.30
|
49.9
|
1.00
|
0.09
|
|
Brown/mixed race
|
44.5
|
1.51 (0.83-2.74)
|
-
|
-
|
44.0
|
0.78 (0.45-1.36)
|
-
|
-
|
|
White
|
48.6
|
1.79 (0.86-3.70)
|
|
-
|
-
|
57.4
|
1.35 (0.76-2.40)
|
|
-
|
-
|
|
Schooling
|
0.01
|
|
|
<0.001
|
|
Primary/Incomplete secondary education
|
35.5
|
1.00
|
1.00
|
|
30.1
|
1.00
|
1.00
|
|
Complete secondary/Incomplete undergraduate education
|
53.1
|
2.05 (1.16-3.64)
|
1.74 (1.01-3.01)
|
0.04
|
53.7
|
2.69 (1.70-4.26)
|
2.17 (1.34-3.51)
|
<0.001
|
Complete undergraduate education
|
20.4
|
0.46 (0.11-1.93)
|
|
0.86 (0.27-2.76)
|
0.81
|
67.4
|
4.80 (2.58-8.92)
|
|
3.39 (1.75-6.56)
|
<0.001
|
Socio-economic status groups
|
|
|
|
D-E
|
32.5
|
1.00
|
0.07
|
|
|
27.0
|
1.00
|
<0.001
|
|
C
|
40.6
|
1.41 (0.67-2.96)
|
-
|
-
|
48.5
|
2.54 (1.47-4.36)
|
-
|
-
|
|
A-B
|
52.6
|
2.30 (1.08-4.89)
|
|
-
|
-
|
56.1
|
3.45 (2.02-5.88)
|
|
-
|
-
|
|
Marital status
|
|
Married/living together
|
43.7
|
1.00
|
0.91
|
-
|
-
|
55.2
|
1.00
|
0.33
|
-
|
-
|
|
Single/separated/widowed
|
42.6
|
0.95 (0.42-2.16)
|
|
-
|
-
|
49.2
|
0.78 (0.47-1.28)
|
|
-
|
-
|
|
Self-report of discrimination during the lifetime
|
|
|
|
No
|
29.3
|
1.00
|
<0.001
|
1.00
|
|
38.8
|
1.00
|
0.001
|
-
|
-
|
|
Yes
|
54.4
|
2.87 (1.69-4.87)
|
|
2.00 (1.18-3.38)
|
0.01
|
54.6
|
1.89 (1.27-2.82)
|
|
-
|
-
|
|
Medical appointment in the last 12 months
|
|
|
|
No
|
33.6
|
1.00
|
0.01
|
1.00
|
|
48.6
|
1.00
|
0.75
|
|
Yes
|
49.9
|
1.96 (1.12-3.40)
|
|
1.74 (1.01-2.99)
|
0.04
|
50.7
|
1.08 (0.64-1.82)
|
|
-
|
-
|
|
Took part of any workshop on STI and HIV/AIDS in the last 12 months
|
|
|
|
No
|
39.1
|
1.00
|
0.03
|
|
|
53.1
|
1.00
|
0.03
|
|
Yes
|
58.3
|
2.17 (1.03-4.57)
|
|
-
|
-
|
41.2
|
0.61 (0.39-0.96)
|
|
-
|
-
|
|
Knowledge about HIV/AIDS (IRT score)2
|
|
|
|
Low
|
38.3
|
1.00
|
0.06
|
1.00
|
|
31.7
|
1.00
|
<0.001
|
1
|
|
Middle
|
39.8
|
1.06 (0.57-1.98)
|
1.13 (0.66-1.96)
|
0.64
|
52.6
|
2.39 (1.37-4.14)
|
2.38 (1.44-3.92)
|
<0.001
|
|
High
|
59.9
|
2.41 (1.08-5.37)
|
|
2.45 (1.05-5.70)
|
0.04
|
61.2
|
3.39 (1.85-6.24)
|
|
2.79 (1.58-4.93)
|
<0.001
|
|
Perception of risk
|
|
|
|
Low
|
38.0
|
1.00
|
0.67
|
|
|
37.3
|
1.00
|
0.11
|
|
Middle
|
45.9
|
1.38 (0.72-2.62)
|
-
|
-
|
51.7
|
1.79 (0.95-3.37)
|
-
|
-
|
|
High
|
42.6
|
1.21 (0.40-3.64)
|
|
-
|
-
|
56.4
|
2.17 (0.91-5.15)
|
|
-
|
-
|
|
Took part of LGBT NGO
|
|
|
|
No
|
39.5
|
1.00
|
0.02
|
1.00
|
|
46.6
|
1.00
|
<0.001
|
1.00
|
|
Yes
|
65.0
|
2.84 (1.12-7.17)
|
|
3.26 (1.29-8.25)
|
0.01
|
64.1
|
2.04 (1.23-3.39)
|
|
2.06 (1.28-3.32)
|
0.003
|
|
Condomless receptive anal sex (past 6 months)
|
|
|
|
Always used condoms
|
42.5
|
1.00
|
0.96
|
|
|
45.1
|
1.00
|
0.01
|
1.00
|
|
Irregular use of condoms
|
42.8
|
1.01 (0.57-1.76)
|
|
-
|
-
|
56.5
|
1.58 (1.09-2.28)
|
|
1.46 (1.00-2.15)
|
0.049
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
¹ Gile-SS weighted proportion of acceptability;
2 Unadjusted weighted odds ratio of acceptability with 95% confidence limits;
3 Adjusted weighted odds ratio of acceptability with 95% confidence limits;
4 Score obtained through Item Response Theory Analysis.