Simulating HIV Transmission Dynamics and Predicting the Impact of Testing Policies in Men Who Have Sex with Men in the UK, France, and Poland
Jul 30, 2020
A Qualitative Study
Published in: Journal of HIV/AIDS & Infectious Diseases, Volume 7, Number 101 (2020): doi: 10.17303/jaid.2020.7.101
Posted on RAND.org on July 30, 2020
Many European countries are on track to meeting the 90-90-90 target set out by UNAIDS in 2014. However, it is estimated that 15% of people living with HIV in the EU/EEA area are still unaware of their status and that almost half of the newly reported cases are diagnosed late. To understand the barriers to testing HIV for the men who have sex with men (MSM) population in Europe, as well as the impact of interventions aimed at addressing these barriers, we undertook a qualitative study focusing on the UK, France, and Poland as well as a pan-European overview, consisting of a targeted literature review, a brief survey, and interviews. We found that barriers to accessing testing for HIV at an individual or patient-level were similar across all countries considered, with an incorrect perception of risk, stigma, and fear of a positive test result rated among the top three barriers to testing for HIV. Healthcare provider barriers viewed as having a big impact on access to testing for HIV in the three individual countries were lack of familiarity with recommendations and guidelines, lack of knowledge or training on HIV, and lack of time. Institutional and policy barriers were considered to have the least impact on impeding MSM from accessing testing for HIV, the main one considered to be criminalization of HIV transmission. Interviewees agreed that any intervention aimed at increasing the testing rate of HIV was a positive contribution to reducing the HIV epidemic. Testing in settings other than specialist healthcare services and social marketing media campaigns were considered to have the biggest impact on encouraging testing in all countries and across Europe. Self-testing was considered to be the intervention with the most potential to address barriers that impede MSM from accessing testing for HIV; however, its availability across Europe remains low.