Background: The introduction of OraQuick® In-home HIV Test (OQ) into the US market in 2012 renewed questions about the use, reach, and public health implications of HIV self-testing (HIVST) for men who have sex with men (MSM). Using baseline data from the Evaluation of HIV Self-testing among MSM Project (eSTAMP), we report on HIV home test (HHT) use and associated factors among MSM.
Methods: Between March 25 and August 4, 2015, MSM reporting HIV-negative or HIV-unknown status were recruited online into a 12-month randomized controlled trial of HIVST. Before randomization all participants completed an online survey. Using these data, we examined participant characteristics and calculated frequency and associations of past 12 months HIVST with selected sociodemographic characteristics. We present unadjusted relative risks (RR) and 95% confidence intervals (95% CI).
Results: Among 2,665 participants [32% 18-24 years; 58% white; 43% ≥college degree; 84% employed; 23% < $20K household income; 63% had anal sex with ≥2 male partners, past 3 months; 6% had condomless anal sex (CAS) with an HIV infected male partner, past 3 months] 59% tested for HIV in the past year, 17% tested ≥3 times in the past year, and 70% had heard of HHTs. Among 10% (259) who reported HIVST in the past year, 92% used OQ and 61% acquired HHTs from a pharmacy. Convenience and privacy were the most common reasons for HIVST, 61% and 52%, respectively. Significant associations with HIVST shown below.

Characteristics (referent is on the right side)ProportionRR (95% CI)p-value
Age (years): 25-39 vs 18-240.10 vs 0.081.34 (1.01-1.78)<0.05
Age (years): 40+ vs 18-240.12 vs 0.081.63 (1.16-2.28)<0.01
Race/Ethnicity: Hispanic vs Non-Hispanic White0.06 vs 0.110.58 (0.41-0.81)<0.01
Education (College Graduate): Yes vs No0.13 vs 0.071.79 (1.41-2.26)<0.001
Employment: Employed vs Unemployed0.11 vs 0.052.09 (1.34-3.27)<0.01
Household income (US $): 40,000 - 74,999 vs <20,0000.13 vs 0.062.21 (1.51-3.25)<0.001
Household income (US $): ≥75,000 vs <20,0000.16 vs 0.062.79 (1.90-4.11)<0.001
Anal sex with ≥2 male sex partners, past 3 months: Yes vs No0.11 vs 0.081.40 (1.09-1.81)<0.01
CAS with HIV infected male partner, past 3 months: Yes vs No0.15 vs 0.091.53 (1.02-2.30)<0.05
[Table 1]

Conclusions: Awareness of HHTs was high, but few MSM reported HIVST in the past year. MSM who engage in HIV sexual risk behaviors may have been earlier HIVST adopters. HIVST was positively associated with higher socioeconomic status possibly due to test cost in the US (approximately $40). Providing free or subsidized tests may be necessary to increase HIVST among MSM in the US, especially among lower income populations.

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