Give the people what they want. According to data presented at the Conference on Retroviruses and Opportunistic Infections 2022 (CROI 2022), when it comes to HIV testing, what people want is to perform those tests at home—and to get them for free.
Starting in September 2021, the Centers for Disease Control and Prevention (CDC) sent free OraQuick home HIV tests to people who requested them on the Take Me Home website. Anyone at least 17 years old could order one or two tests from the site. After their initial order, they could request tests again in 90 days. The CDC advertised the tests specifically to Black and Latino gay and bisexual men, transgender women of all races and ethnicities and Black cisgender women—groups with the highest lifetime risk of acquiring HIV. The CDC also targeted advertisements to communities that are part of the Ending the HIV Epidemic initiative.
CDC epidemiologist Pollyanna Chávez, PhD, described the program and its outcomes at a CROI session and media briefing.
While the CDC planned to run the program through February 2022, the agency ran out of the 100,000 self-tests set aside for the program in October 2021. More than half of those who ordered tests lived in Ending the HIV Epidemic communities. Specifically, the greatest number of orders came from California, Texas, Illinois, Florida, Georgia and New York. Most people ordered two tests at a time.
The program seemed to reach many communities that don’t receive enough testing. A total of 57,277 test recipients filled out an optional survey; 77% of them completed the full survey. Of those, 59% had either never been tested for HIV (26%) or had not been tested in the last year (33%). By age, 81% of 17-year-olds tested for HIV for the first time using self-tests, as did 46% of people ages 18 to 24 and 21% of those ages 25 to 34.
The tests reached people who were at risk for HIV and could benefit from testing and, potentially, pre-exposure prophylaxis (PrEP), with 74% of participants reporting that they had two or more sexual partners. The survey did not ask about the partner’s HIV status or viral load. About 2% of these tests went to people who had previously tested HIV positive, and another 5% went to people using PrEP.
So how well did the program do at reaching Black and Latino gay and bisexual men, cisgender Black women and women of transgender experience? Here are the numbers:
- Black and Latino men who have sex with men (MSM) made up 56% of those newly diagnosed with HIV in 2018, according to the CDC. This group accounted for just under half of those who received an HIV self-test—32% were Latino, of whom 19% had never tested before, and 16% were Black, of whom 20% hadn’t tested before.
- Cisgender women accounted for 16% of new HIV diagnoses in 2018, with the vast majority of those (58%) occurring among Black women. In this project, 26% of tests went to cisgender women, 43% of whom were Black. More than one in five of those Black women (22%) had never taken an HIV test.
- People of transgender experience accounted for 2% of new HIV diagnoses in 2018, with 92% of those being trans women and a majority being Black, Latina or mixed race. In this project, 2% of people who ordered self-tests identified as transgender women, 24% of whom had never been tested before. In addition, 2% identified as genderqueer, 26% of whom had never tested before. And 1% identified as transgender men, a full 31% of whom had never taken an HIV test. A total of 40% of the trans men said they had had anal sex with a man in the last year, while 79% of trans women and 72% of genderqueer people had done so.
In addition, Native Americans, who have increasing rates of HIV, accounted for 2% of people who ordered self-tests. American Indian or Alaska Native gay and bi men made up 1% of the MSM who ordered tests. One in five of them had never been tested for HIV before. Likewise, 1% of the cisgender women who ordered tests were American Indian or Native Alaskan, 29% of whom had never tested before. There were no data on how many American Indian or Alaska Native transgender and gender-diverse people received tests.
Click here to read the study abstract.
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