HIV testing cascade among men who have sex with men at higher HIV risk in Serbia

BACKGROUND: Successful HIV prevention requires motivation, access, and effective use by priority populations. Accessible and non-stigmatizing HIV voluntary counseling and testing (VCT) is the first step towards timely diagnosis. In Serbia, there is a concentrated HIV epidemic among men who have sex with men (MSM), with 49.2% of new diagnoses being detected late in 2021, based on initial CD4 cell count. We examined key aspects related to HIV testing among a high-risk sample of Serbian MSM to improve national HIV prevention guidelines. METHODS: A bio-behavioral cross-sectional respondent-driven sampling study among MSM in 4 cities in Serbia was conducted in 2021 (N = 1,300). We analyzed HIV testing among MSM who had unprotected anal sexual intercourse (UAI) in the last 12 months. The motivation pillar was operationalized as adequate knowledge of where VCT services can be obtained, the access pillar was operationalized as having ever had HIV testing, and the effective use of the VCT service pillar was operationalized as HIV testing in the last 6 months. RESULTS: Of all MSM reached, 63.8% had practiced UAI in the last 12 months, of whom 66.47% knew where to access VCT services. Of these, 88.9% had even been tested for HIV, yet only a quarter (25.5%) had been tested in the last 6 months. Therefore, only 15.1% of MSM who practiced UAI in the last 12 months had been recently tested for HIV. CONCLUSIONS: HIV testing rate is high among Serbian MSM if they have adequate knowledge of where VCT services can be obtained. However, even though community-based VCT among MSM is subsidized by the Ministry of Health of the Republic of Serbia, the effective use of the VCT services is very low among high-risk MSM. This suggests that VCT service promotion must be transformed to be both visible and culturally sensitive to the Serbian MSM community. VCT protocols should also encourage regular testing (at least every 6 months) for those most at risk for HIV acquisition.