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    • In the Joint United Nations Program on HIV AIDS UNAIDS

    2022-09-24

    In 2015, the Joint United Nations Program on HIV/AIDS (UNAIDS) proposed that by 2020, 90% of people living with HIV should be aware of their HIV status, as the first part of 90-90-90 strategy to end AIDS epidemic. Early detection of HIV allows initiating care for proper treatment, which impacts in morbidity, mortality, and reduces further transmission. In Brazil, HIV testing is recommended for all pregnant women and patients with diagnosis of tuberculosis, visceral leishmaniasis, or sexually transmitted infections. Studies estimated that the delay between infection and first CD4 count in Brazil was 4.3 years, showing that a large proportion of individuals still started treatment late in the country. In Northeast Brazil 8800 new cases of AIDS are detected per year and in Natal the mean CD4 count at diagnosis is 269cells/mm3, pointing to late diagnosis of HIV. Although the group of MSM accounts for the highest prevalence of HIV in the country, there is no specific recommendation for HIV testing in this TIC10 sale in Brazil. Data available from developed countries show that the proportion of MSM never testing for HIV is generally below 30%.8, 9 Since few studies evaluated HIV testing among MSM in Brazil, especially in Northeast region, our study aimed to access the rate and factors associated with HIV testing among MSM from Natal city, Northeast Brazil.
    Materials and methods
    Results By November 2012, 70 subjects were included using RDS, despite many efforts of the study team to improve recruitment, including increase in the hours of operation of the study site and adding six more seeds. As our planed sample was 95 MSM, we decided to include a venue-based sample of additional 31 subjects recruited during the gay pride event in Natal city in December 2012. From 101 participants, two were excluded because they answered less than 70% of the questionnaire, totaling a sample of 99 subjects. Sociodemographic characteristics of participants are shown in Table 1. The mean age was 29.1 years (SD 9.7 years), 73.3% identified themselves as mulatto or black, mean monthly income was 494 US dollars (SD 465 dollars), and 61.5% were employed. Participants had a mean of 11.5 years of schooling (SD 2.2 years). Out of 99 participants, 62.6% (CI 95% 52.5–71.7%) had been tested for HIV, 46.2% (CI 35.5–57%) in the last year. The most frequent reason to be tested was curiosity (35.5%), 17.7% because they perceived themselves to be at risk for HIV infection, and 16.2% were asked to be tested by a health professional (Table 2). The most frequent place for testing was public services mentioned by 52.4% (Table 3). Only 9.2% of participants had adequate knowledge about HIV transmission. The questions with the highest percentages of wrong answers were “Can a person get HIV by sharing a meal with someone who is infected?” (66.7% marked ‘yes’) and “Can a person get HIV by using public toilets?” (22.9% marked ‘yes’) [Table 4]. Transactional sex was frequent, as 42% reported having received money in exchange for sex in the previous six months. Use of condom in the last anal intercourse was mentioned by 71.9%. Only 13.1% were aware of the HIV status of sexual partners. Of the 63 MSM who agreed to perform an HIV test, six turned out positive (9.5%) [Table 1]. In univariate analysis, age (PR 0.93; 95% CI, 0.88–0.97; p<0.001) and previous syphilis test (PR 1.85; 95% CI, 1.41–2.44; p<0.001) were associated with HIV testing. Knowing a place where the HIV test could be done free-of-charge was also associated with HIV testing (PR 1.69; 95%CI, 1.05–2.71; p=0.017), as most MSM did the test in public services (Table 5). In adjusted analysis, resulted from Poisson modeling, the variables “age”, “previous syphilis test”, and “knowing where HIV test was free” where included in a stepwise logistic regression analysis. In the final predictive model only “age” and “previous syphilis test” remained independently associated with previous HIV testing (Table 5).