“If not for online testing, I would never get tested”: Willingness for online HIV testing among app-using YMSM in Bangkok
Nattharat Samoh, Pimnara peerawaranun, Yamol kongjareon and Thomas E. Guadamuz
Thailand is currently experiencing an escalating HIV epidemic where 1 in 3 YMSM in Bangkok are living with HIV and most of them do not even know their status. HIV stigmatization among health care providers toward YMSM—including YMSM-related stigma (e.g. promiscuous)—is a major barrier to HIV testing in Thailand. Other testing modalities, like anonymous self-testing, may be an important alternative. This study examined the willingness for online HIV testing (OHT) among app-using YMSM in Bangkok, Thailand.
Using mixed methods, data were obtained from eight focus group discussions (FGDs) (n=48) and online anonymous survey (n=1,394) from 18-24 year-old MSM. NVIVO 11 and STATA 14 were used to manage and analyzed qualitative and quantitative data, respectfully.
Of participants, 87% was willing to test online. Correlates of willingness to test online include: never having tested before (46.7% VS 38.4% p=0.038), being sexually active (70% vs. 60%, p=0.005), having 2 or more sexual partners (60% vs. 48%, p=0.02), and seeking partners online (80% vs. 70%, p=0.007). From the FGDs, reasons for OHT include reduction of time and complicated process, and most importantly, not having to go to testing venues where they may face stigma. Some men said that “[they] have been at the testing clinic and saw someone [they] know and so decided to go home without testing.” Others said that OHT is easy and should be available to everyone: “I will even pay money to do online testing [after the termination of the research study].” Finally, some participants said that they worry about confidentiality because they have heard that counselors will tell their friends and other YMSM of people’s positive status.
OHT seems to be most suitable for high-risk YMSM who regularly navigate the online space. Moreover, OHT is also appropriate for Thai society because there is heightened HIV stigma and a “culture of gossip” among health care providers and YMSM; these contexts may be similar to neighboring ASEAN member countries. Having multiple options for YMSM, who are clearly at very high risk for HIV, is critical if we want to reach the UNAIDS 90-90-90 targets.