HIV self-testing in Spain: A valuable testing option for men-who-have-sex-with-men who have never tested for HIV

BACKGROUND: We assessed the capacity of HIV self-testing to promote testing among untested men who have sex with men (MSM) and determined the most benefited subpopulations. METHODS: An online questionnaire was disseminated on several gay websites in Spain from September 2012 to April 2013. We used Poisson regression to estimate factors associated with the intention to use self-testing if already available. Among those who reported intention of use, we assessed several aspects related to the testing and linkage to care process by type of barrier reported: low perceived risk (LR), structural barriers (SB) and fear of testing positive (FTP). RESULTS: Of 2589 never-tested MSM, 83% would have used self-testing if already available. Intention of use was associated with age ≥30 (adj.PR, 95%CI: 1.05, 1.01–1.10), having had protected (adj.PR, 95%CI: 1.15, 1.02–1.30) or unprotected (adj.PR, 95%CI: 1.21, 1.07–1.37) anal intercourse and reporting FTP (adj.PR, 95%CI: 1.12, 1.05–1.20) or SB to access HIV testing (adj.PR, 95%CI: 1.23, 1.19–1.28). Among those who reported intention of using a self-testi, 78.3% declared it their preferred option (83.8% in the SB group; p<0.001), and 56.8% would always use this testing option (60.9% among the SB group; p = 0.001). In the case of obtaining a positive self-test, 69.3% would seek confirmatory testing, 15.3% would self-test again before taking any decision and 13.0% reported not being sure of what they would do. CONCLUSION: HIV self-testing in Spain has the potential of becoming a highly used testing methodology for untested MSM and could represent the gateway to testing especially among older, at risk MSM who report SB or FTP as main barriers to testing.