Use of a Rapid HIV Home Test Prevents HIV Exposure in a High
Risk Sample of Men Who Have Sex With Men
Alex Carballo-Die ´guez•Timothy Frasca•
Ivan Balan•Mobolaji Ibitoye•Curtis Dolezal
Published online: 15 August 2012
? The Author(s) 2012. This article is published with open access at Springerlink.com
fected men who have sex with men (MSM) who never or
rarely use condoms and have multiple partners would use a
rapid, oral fluid, HIV home test (HT) to screen potential
sexual partners. Participants received 16 HT kits, were
monitored weekly for 3 months, and then interviewed in
depth. Twenty-seven ethnically diverse MSM used HT kits
before intercourse with approximately 100 partners in pri-
ethnic minority participants. Ten tested individuals received
HIV-antibody positive results. Seven were potential sexual
partners, and three were acquaintances of the participants;
six of the ten were unaware of their status. No sexual inter-
course took place after positive tests. Very few problems
occurred. Most participants strongly desired to continue
using HT and to buy it freely. HT use results in detection of
networks where high-risk sexual practices are common may
be a cost-efficient and effective prevention method.
The study assessed whether at-risk HIV-unin-
sexo con hombres (HSH), que son VIH-negativos y tienen
pra ´cticas de riesgo –nunca o rara vez utilizan condones y
tienen mu ´ltiples parejas– usarı ´an una prueba ra ´pida oral de
VIH apta para el uso casero (HT por sus siglas en ingle ´s),
para determinar el estatus de VIH de sus parejas sexuales
potenciales. Los participantes recibieron 16 equipos de HT,
fueron monitoreados semanalmente durante tres meses y
El estudio evaluo ´ si los hombres que tienen
luego entrevistados en profundidad. Veintisiete HSH de
diversas etnias, utilizaron los equipos de HT antes del coito
con aproximadamente 100 parejas, tanto en lugares pu ´bli-
cos como privados. El usar la prueba con parejas sexuales
potenciales, tuvo una alta aceptabilidad entre los partici-
pantes de minorı ´as e ´tnicas. Diez individuos recibieron
resultados positivos para VIH. Siete eran parejas potenciales
y tres eran conocidos); de ellos, seis no sabı ´an de su estatus
seropositivo anteriormente. No hubo coito despue ´s de
obtener resultados positivos. Hubo muy pocos problemas.
La mayorı ´a de los participantes expresaron fuertes deseos de
seguir utilizando el HT y de poder comprarlo libremente.
La utilizacio ´n de HT da como resultado la deteccio ´n de
infecciones previamente desconocidas. El poner el HT a
disposicio ´n de redes sociales donde las pra ´cticas sexuales
de alto riesgo son comunes, puede ser un me ´todo de pre-
vencio ´n costo-eficiente adema ´s de efectivo.
HIV ? Rapid testing ? Home testing ? MSM ?
Biomedical strategies for the prevention of HIV transmis-
sion recently have met with considerable success. Ten-
ofovir gel applied vaginally was initially shown to decrease
HIV transmission by 39 % among women who have sex
with men  (although a later study  did not replicate
the findings), and Truvada (emtricitabine and tenofovir
disoproxilfumarate) pills ingested daily as pre-exposure
prophylaxis (PrEP) showed a 44 % transmission reduction
among men who have sex with men (MSM) . Although
both strategies showed only partial efficacy against HIV
transmission, they were hailed as breakthroughs given that
A. Carballo-Die ´guez (&) ? T. Frasca ? I. Balan ? M. Ibitoye ?
HIV Center for Clinical and Behavioral Studies at New York
State Psychiatric Institute and Columbia University,
1051 Riverside Drive, Unit 15, New York, NY 10032, USA
AIDS Behav (2012) 16:1753–1760
more than 30 years into the HIV epidemic many people at
risk of HIV infection cannot or will not be abstinent or use
condoms consistently. Alternatives are sorely needed.
Consequently, discussions are underway for FDA licensing
of Tenofovir gel and Truvada for PrEP purposes [4, 5].
Truvada as PrEP is also being piloted in community
demonstration projects in San Francisco and Miami [6, 7].
A biomedical strategy that has received little attention
despite its ready availability is the possible use of rapid
HIV test kits at home (home testing or HT) to screen sexual
partners. While advocates have touted the need for HT as a
way to increase access to HIV testing, prompt earlier
testing, and increase personal HIV status awareness and
autonomy [8, 9], very few [10, 11] have recognized its
potential for partner screening to reduce sexual risk. An HT
kit that can deliver results almost immediately is not yet
available for over-the-counter sale (OTC) in the United
States, but this will soon change. The FDA recently
approved for OTC sale the OraQuick In-Home HIV Test,
an oral fluid test that requires no professional training for
its administration or interpretation, can deliver results in
20 min, and has a sensitivity of 92 % and a specificity of
99.98 % . An FDA advisory panel had previously
unanimously recommended its OTC licensure [13, 14].
Once available, people may use HT to obtain information
about the HIV status of a sexual partner prior to intercourse
and to decide what protective strategy, if any, to use. A
caveat is that OraQuick is an antibody test; therefore, an
HIV-infected individual may appear uninfected until anti-
bodies are generated. The window period of antibody tests
lasts 25 days on average and in some cases as long as
8 weeks . Thus, despite the high sensitivity and spec-
ificity of OraQuick, using it to screen sexual partners still
would not completely eliminate risk. However, it would be
another partially efficacious strategy for HIV-transmission
prevention like the microbicide gels and PrEP currently
being studied and piloted, as well as other existing HIV
harm reduction approaches. For populations with high HIV
prevalence such as MSM, and especially in urban areas
where ethnic minority men have HIV-prevalence rates
comparable to those of sub-Saharan Africa , HT could
offer higher levels of protection than inconsistent condom
use [17, 18]. Prior studies have shown that even among
MSM who intentionally engage in unprotected anal sex
when risk of HIV infection is present (‘‘barebacking’’)
[19, 20] and who prioritize sexual pleasure and intimacy
over protection against infection [21, 22] there is concern
about and wish to avoid HIV infection [22, 23].
Our study was designed to test whether MSM who
seldom or never use condoms and have sex in risky cir-
cumstances would use HT to screen sexual partners prior to
intercourse. The Information, Motivation and Behavioral
Skills (IMB) model  guided our inquiry into whether
men with sufficient information on HT (including its
limitations) would be motivated to use it to screen partners
and what behavioral and negotiation skills they would
employ to succeed at using HT for screening purposes. The
results of the first stage of the study (hypothetical use),
have already been published  (also see commentary
). Briefly, the men in the sample (N = 57) were able to
understand the information we provided them on HT
characteristics and limitations, specifically those referring
to the window period and acute infection. Over 80 % of
participants said they were motivated to use the kit to test
sexual partners or themselves if the test became available
OTC. Furthermore, 74 % of the participants in the first
stage of the study demonstrated their skills by testing
themselves unassisted in front of a research assistant in our
offices and then correctly interpreting the test results.
We now present the results of the second (experiential)
stage of the study. In this stage men were given HT kits to
take home with the possibility of using them with their
sexual partners over a 3-month period.
Our study was conducted in New York City, USA, with
approval from the New York State Psychiatric Institute
Institutional Review Board. Recruitment took place in
person and online at sites frequented by gay men with
advertisement indicating that researchers were studying
possible uses of a rapid HIV home test. Study candidates
called the research office and responded to a few pre-
screening questions. Those who qualified were invited to
an in-person screening interview (Visit 1). After consent
procedures, men were given a comprehensive description
of rapid HIV HT, how it worked, and its window-period-
related limitations. Subsequently, they took the first half of
a 2-part, computer-assisted self-interview (CASI) that
collected, inter alia, demographic information, HIV
knowledge , sexual risk behavior in the prior 3 months,
alcohol and substance use history, and prior history of
STIs. Next, participants tested themselves with OraQuick
following written instructions while monitored by a
researcher. While waiting 20 min for the result of the test,
participants completed the second part of the CASI. It
included, among other sections, questions on whether the
participant intended to use HT with partners when it
became available OTC; his perceived capacity to discuss
the use of HT with a partner and handle potentially positive
results; his perceived ability to judge whether a partner
could become violent and avoid or handle violent situations
(adapted from ); and an 18-item questionnaire (true/
false) specifically developed for this study on rapid HIV
tests and their limitations, specifically the window period.
1754 AIDS Behav (2012) 16:1753–1760
Any incorrect responses to the last questionnaire generated
feedback to the participant with the correct answer and its
rationale; furthermore, the research assistant provided
added clarification if necessary.
Negative HIV test results obtained with OraQuick at this
visit and interpreted unaided by the participant were con-
firmed using a second rapid test (Clearview? Complete
HIV 1/2) that is blood-based. The data collected during this
screening process allowed us to determine participant
Eligibility criteria included: man; 18 years of age or
older; fluent in English or Spanish; HIV-negative; not in a
monogamous relationship; engages in anal intercourse at
least three times per month; never or seldom uses condoms
(no condom use in last 10 occasions for those with 4 or less
partners or in less than 80 % of occasions for those with
more than 4 partners in the past year); aware that unpro-
tected receptive anal intercourse (RAI) may lead to HIV
transmission; understands the window period of OraQuick;
reports likelihood of using HT to screen potential sexual
partners; and feels he can avoid or handle potential
violence resulting from proposing to use the test.
Study candidates who fulfilled eligibility criteria
returned to the research offices on a subsequent day (Visit
2). After a new consent process, they enrolled in the
3-month study. They received a bag containing condoms,
16 HT kits, written instructions on HT kit use, a card with
HIV- and violence-related resources available in the com-
munity, the study Website address, and a 24-h hotline
number they could use for assistance from two senior
clinical psychologists supervising the study. Participants
were also trained on how to use an interactive voice
response system (IVRS) to call at least once per week to
report their sexual behavior and HT use. If no call was
placed in a week, participants received an automatic
reminder generated by the system. If they did not respond
to the reminder, a staff member called them personally.
Staff also called in response to any IVRS report of an HIV-
Visit 3 took place 3 months after Visit 2. Participants
underwent an in-depth interview conducted by a clinical
psychologist following an interview guide. The guide
explored the constructs of the IMB model with specific
attention to motivational factors that led participants to use
(or not use) the test with different partners and the skills
they employed to propose and use HT, interpret results, and
handle partners’ reactions. Furthermore, in the course of
this interview, a summary of the data collected through the
IVRS was discussed and ambiguous issues clarified.
Participants received between $30 and $70 as compen-
sation for their time at the different visits, plus a modest
monetary incentive per call and a bonus if calls were
received at least once a week, for a possible total of $190.
Quantitative CASI data were analyzed using SPSS  to
calculate descriptive statistics.
In-depth interviews were recorded, transcribed, and
checked for accuracy. Repeated reading of transcripts by a
team of four researchers led to the identification of the
main themes that constituted the basis for codebook
development. Codes were defined with inclusion and
exclusion criteria including examples. All transcripts were
double-coded, and discrepancies discussed until reaching
consensus. Codes were reviewed to identify modal
responses, cases that contradicted the main trends, and
quotes to be included in the text.
Sample Description and Baseline Behavior
Approximately one out of eight potential study volunteers
who contacted us passed the pre-screening criteria. Forty-
four men initially qualified and were invited to attend the
in-person screening Visit 1. Of these, 12 did not qualify for
enrollment due to the following reasons: three tested HIV-
positive; three did not feel capable of handling violent
situations; three did not report qualifying risk behavior
despite their initial pre-screening profile; one participant
reported that he would not ask a partner to use HT under
any circumstances; and one was unable to understand the
window period of the test despite clarification from the
research assistant. In addition, two participants were
excluded when they provided contradictory or false data.
(One participant was disqualified for two of the above
Of the 32 participants enrolled in the study, four did not
complete all study procedures and a fifth case was dis-
carded due to unreliable data. The men who completed the
study did not differ from the excluded men in terms of their
expressed likelihood to use the test on themselves;
although they were marginally less likely to use HT with
partners (P = .051), their answers were nevertheless
within the likely-to-use range.
The final sample consists of 27 men. Table 1 presents
their sociodemographic characteristics.
Table 2 shows that participants had engaged in signifi-
cant sexual risk behavior in the prior 3 months as evi-
denced by their multiple partners and frequency of
unprotected receptive and/or insertive anal intercourse.
Almost all participants reported consuming alcohol in the
prior 3 months, slightly over half used marijuana, and more
than one-third used other drugs. Almost half of the par-
ticipants had had an STI in the course of their lives, the
AIDS Behav (2012) 16:1753–17601755
the sample reported having had three or more STIs in
their lives. By study design, all participants were
frequentbeing gonorrhea.Fifteen percentof
HIV-uninfected. Eighty-eight percent of them reported
having been tested for HIV within the past 2 years.
Utilization of HT Kits
According to IVRS and in-depth interviews, the participants
had approximately 140 sexual partners during the 3 months
of study. They proposed using the kit to about 124 men of
whom 101 accepted and 23 refused. Ten tested individuals
got HIV-antibody positive results. Seven were potential
sexual partners and three were acquaintances of the partici-
pants; six of the ten were unaware of their status. Two par-
ticipants each tested two partners who got positive results.
Below, we present excerpts from in-depth interviews
that characterize in the participants’ words their experi-
ences using HT. Each quote includes participant ID, age,
and ethnic group in parentheses.
Participants liked having access to HT for use with
partners and found it easy to use.
You just swipe it once on the top [gum], swipe it once
on the bottom, and then put it in the test tube and stuff
like that. It’s pretty easy. Simple. (#1014, 25 years
Although about one-fifth of the partners refused to use the
test and left the place of the encounter, most partners were
receptive to using HT prior to sex.
People were a lot more willing to try the test than I
was expecting,… and I had no problems, no hostility
or anything toward me asking them to take the test.
And it went perfectly fine. (#1035, 19, L)
Lack of partner resistance to taking the test was seen as a
good sign. When partners resisted, participants often
interpreted it as a warning not to have sex with that person.
And the ones that wasn’t with it, either I didn’t do
nothing with them, or I used a—or I used a condom
with them. Yeah, ‘cause I just didn’t trust it ‘cause I
was thinking they was infected.’’ (#1014, 25, AA)
Most participants used HT at home, but 17 of them
reported carrying the kits and using them at their partners’
homes or even in public places.
At this point, I start carrying some of them with me,
the tests with me. So just in case anything happens, I
have my little plastic baggie, open it up, do what we
have to do. And we went to his place, and I said, you
know, I really like you, this is really hot, and I think
we can really have fun here. How would you like to
test with me? (#1015, 33, W)
It was a little awkward to wait in the bathroom at the
supermarket, waiting for the results. (#1035, 19, L)
Table 1 Sociodemographic characteristics of participants (N = 27)
Mean (SD) [range]
Age 34.0 (11.4) [18–58]
Income (in thousands) 20,587 (22,863) [0–90,000]
High school graduate or less9 (33 %)
Partial college11 (41 %)
College graduate or more7 (26 %)
White 11 (41 %)
Latino 4 (15 %)
Black 9 (33 %)
or mixed ethnicity
3 (11 %)
Table 2 Sexual risk behavior, substance use, and history of STIs
(N = 27)
Sexual risk behavior in the prior 3 months
Number of male partners 15.3 (17.8) 10 [3–90]
Unprotected receptive anal intercourse
10.8 (16.3) 4 [0–80]
Unprotected insertive anal intercourse
9.1 (18.6) 2 [0–80]
Alcohol or drug use in the prior 3 months
Alcohol 25 (93 %)
Marijuana15 (56 %)
Poppers 10 (37 %)
Other10 (37 %)
Lifetime history of STIs
Ever had an STI13 (48 %)
Gonorrhea8 (30 %)
Chlamydia 4 (15 %)
Syphilis4 (15 %)
Pubic lice2 (7 %)
Other 6 (22 %)
Number of people reporting having
had 1 STI in the past
6 (22 %)
Number of people reporting having
had 2 STIs in the past
3 (11 %)
Number of people reporting having
had 3 or more STIs in the past
4 (15 %)
1756AIDS Behav (2012) 16:1753–1760
Often, mutual testing took place.
I did it for him, and he did it for me. We opened the
kits, you know, like put them side-by-side. And I
swabbed him. He swabbed me. We put it in. And then
we waited the 20 min, which seemed like a lifetime
[laughs]. (#1017, 47, W)
Although waiting 20 min for the results provoked anxiety in
reported playing video games, watching TV, eating, drink-
found the wait beneficial to ponder what to do next.
The 20-min window sort of gives you that extra
20 min to decide, ‘‘Okay, if this comes back negative,
am I really ready to bareback?’’ (#1017, 47, W)
Substance use was frequent in this sample (only three
participants reported no substance use); yet, in most cases
it did not appear to hamper HT use.
If you would just meet somebody in a bar, having a
few drinks, some of the inhibitions come down, the
walls come down, and other topics of conversation
are available to come above to the surface. So I think
with the alcohol with the testing, I think it was just
the way that I can incorporate the tests into the
conversation or between our engagement as not a
tool, but just as a preface to go on to do other things.
(#1016, 43, W)
Two prospective partners knew they were infected with
HIV and disclosed it to the participant when he proposed to
use HT. In one case the partner stated that as he was
planning on using condoms and his viral load was
undetectable, there had been no need to disclose his status
before. Conversely, six out of seven partners with reactive
tests were unaware of their positive status and found it out
So we’re chatting at dinner, and it’s definitely leaning
in the sexual area […] And it built up into let’s go to,
you know, let’s go to your place […]. Matter of fact,
when we get there, since I’m already part of this
study, you know, about basically HIV awareness, and
risk, and risk taking, why don’t I test in front of you,
would you like to test with me? Cool, that would be
great. Then we can have as much fun as we want.
You know, and it went really, really well. And then
he got the [positive] result [laughter]—He had no
idea, I guess. […] He’s like, What do you mean? I’m
pretty sure it didn’t give you a false positive, this is a,
you know, this is pretty straightforward. Listen, I still
like you, we can still fool around if you want to. You
know, I don’t know what you’re going through at the
moment. I know for me, when I found out about the
Hep [Hepatitis C], I thought my world had come to an
end. […] So if you want to hug, I’ll give you a hug,
like, I’m here for you. […] And he got pretty upset,
you know, it was hard to see that. I said listen, I’ll go
with you, if you want to go to another clinic and get
retested, if you want me to bring you down to, you
know, one of the counseling centers, if you want to
contact the people in my study, I can do that. He just
said, you know, I’d really like to just kind of take
some time alone. And I said, Are you going to be all
right? You know, like, I worried he might do some-
thing crazy, you know, and I really didn’t want to see
that happen. So, I gave, you know, I left him with my
number, I said, If you need to call me, please do. You
know, please leave all the sexual stuff aside, like,
you’re another person, and I care, you know? We can
always fool around later if you want to, but that
doesn’t change how I feel about you and what I think
of you. So, you know, nothing really happened after
the testing, but as far as I know, he said he was going
to go get services. [Afterwards] I left him a message
and texted him, but I don’t want to be pushing it,
obviously, because he’s going through a lot. (#1015,
There were very few adverse experiences. Out of the
approximately 124 occasions in which participants invited
their partners to use HT, seven led to verbally aggressive
situations (two participants reported two aggressive situa-
tions each); none of them resulted in violence towards the
participant. In one case the sexual partner became angry
with the participant when he proposed to use HT
unexpectedly during the sexual event. In another case a
partner who tested positive stomped on the test kit and
started cursing; he did not attack the participant. The
participant described this partner as a rough, belligerent
type who could react negatively but with whom he decided
to go anyhow and propose HT use. One participant whose
partner reacted aggressively said that he (participant)
always carries a weapon when he goes to someone’s
home, thus indicating that he anticipates violence and gets
involved in potentially violent situations. Of the four calls
that were made to the hotline, all dealt with questions about
interpretation of test results; none was due to a violent
episode as a result of using HT.
No UAI occurred in any of the cases in which a par-
ticipant found that a prospective partner was HIV-infected.
out or whatever like that, but I didn’t wind up having
sex though. It definitely put it in my mind that I
shouldn’t have sex with the person. (#1030, 26, L)
AIDS Behav (2012) 16:1753–1760 1757
Participants were three times more likely to report that
using HT made them reduce their risk, be more cautious,
practice safer sex, or think more about whom to have sex
with than they were to report that use of HT made them
more likely to have UAI.
Because I’ve been in the study […] I’m kind of
ruined from having sex with people where I don’t
know what their status is. But I’ll tell you this, I
always ask now. That’s the closest I can come to
knowing, and I want as much of that kind of feeling
as I can get. And it always makes me wish I had the
test to see if I was right. (#1021, 58, AA)
Participants felt they could trust the test, and although
they thought the test was not for everyone, they hoped it
would soon be available OTC
I wish there were tests for everything, for syphilis, for
gonorrhea, for meningitis, for tuberculosis. That
happened to me one time where somebody—oh, what
a mistake. I met somebody in a bathhouse […] in St.
Louis and bought him a ticket to come out and see
me. And he never came. I got a phone call from his
friend who said he died, passed away, that he had
tuberculosis and AIDS, and he didn’t tell me either of
these things. That’s why it’s good. Had that been the
case that I would have mentioned to him on the
phone, you know, do want to visit me in New York
City? By the way, I have this test kit. Would you be
willing to take this test? Then maybe he’d ‘fess up
and say, Well, I better tell you the truth. I am posi-
tive. And then I would, Thank you very much. See
you later. So I think this will definitely save lives,
definitely. (#1020, 56, W)
Besides giving additional support to the findings of the first
(hypothetical) stage of our study, the results reported here
give proof of concept that HIV-uninfected MSM from
diverse ethnic backgrounds who never or rarely use con-
doms and have intercourse with multiple partners under-
stand the limitations of HT and are willing and able to use
HT to screen partners. Most importantly, our results show
that use of HT results in prevention of HIV exposure. The
high yield of positive results (about 10 % of tested indi-
viduals were found to be infected) and the high proportion
of partners (60 %) who were previously unaware of their
infection show that HT may be a very effective and cost-
efficient strategy for HIV detection. Moreover, availability
of HT may result in more frequent testing among indi-
viduals with high-risk behavior, earlier detection of new
infections, and distribution of test kits among network
acquaintances presumably also engaging in high-risk sex.
This is particularly promising in light of recent studies that
have shown high rates of UAI among MSM who serosort
based on the assumed serostatus of their partners (‘‘sero-
guessing’’) as well as infrequent and low HIV testing rates
among serosorters [29–32].
Beyond actual use, the availability of HT and intention
to use it may result in initiation of a discussion of HIV-
related concerns and more honest disclosure of HIV-posi-
tive status from individuals aware of their infection. While
prior studies have shown that MSM are less likely to dis-
close their HIV-positive status to casual or anonymous
sexual partners than to main sexual partners [33–35],
among our sample of MSM who had multiple casual
partners, HT use led to several discussions on HIV pre-
vention and prompted two partners to disclose their sero-
positivity.The method appeared
acceptability not only among White MSM but also among
ethnic minority MSM, a population hard hit by the epi-
demic for which many HIV-prevention approaches have
failed and effective interventions are much needed .
The window period of the oral fluid test used in this
study remains an issue—one upon which the biggest con-
cerns about using HT to screen sexual partners will be
raised. Yet, participants in our study understood and
remembered the window period limitations. For instance,
only one out of 44 individuals screened for the study was
deemed ineligible to participate because he did not
understand the concept of the window period. On the other
hand, several participants referred to the window period
while discussing their sexual behaviors during the in-depth
interview at the end of the 3-month study. Furthermore,
new tests are being developed that reduce the length of the
window period. For example, Determine HIV-1/2 Ag/Ab
ComboTM, a fourth generation, rapid in vitro immunoassay
qualitatively detects HIV p24 antigen as well as antibodies
to HIV-1 and HIV-2 in serum, plasma, and whole blood.
The p24 antigen is produced during the first few weeks of
HIV infection and is detectable 7–9 days earlier than HIV
antibodies. Test results can be read in 20 min .
Although this test is not yet available in the US, new rapid
OTC tests undoubtedly will become available in the future
with shorter window periods that could increase the pre-
vention potential of HT.
Another potential barrier to the adoption of HT as a risk
reduction strategy is the concern that it might lead users to
take additional risk. Similar arguments have been raised in
regards to other HIV risk reduction techniques including
needle exchange programs—a successful strategy whose
implementation was delayed for years despite ample
research findings demonstrating its utility [38–40]. Just as
the provision of clean needles to injection drug users was
to have ample
1758 AIDS Behav (2012) 16:1753–1760
once feared to promote substance use, the use of HT to
screen sexual partners is at this point a cutting-edge strat-
egy that faces an uphill battle. While some may argue that
people will ‘‘migrate’’ from condom use to the less reliable
strategy of HT screening thereby increasing their HIV risk,
it should be noted that our study was conducted with MSM
who never or seldom use condoms. Therefore the adoption
of HT among this population would not replace their
sporadic condom use but instead provide them with an
additional risk reduction option [17, 18].
Use of HT as a screening tool may result in public health
savings much needed in times of budget constraints. For
example, the current cost of OraQuickTMis less than $20
per kit, depending on the number of units purchased, and
NGOs are working to reduce the price of rapid HIV testing
kits . By contrast, the estimated yearly cost of using
TruvadaTMas PrEP is $10,000 per person/year .
Generalization of our results should be made with cau-
tion. Our sample was small. Our eligibility criteria were
very strict and resulted in a highly selective sample of
MSM with high-risk sexual behavior and history of fre-
quent STIs yet HIV-uninfected; they were recruited based
on their stated intention to use HT and their professed self-
confidence that they could handle potential violence.
Therefore, they may not be representative of other MSM
who engage in high-risk sexual behavior. Furthermore, the
marginal difference between dropouts and completers in
their intention to use HT with partners requires further
study; it may indicate an effective opt-out of the technol-
ogy by those who feel ill equipped to employ HT with
Despite these limitations, our study highlights the
important potential of use of HT as an HIV-prevention
strategy for MSM who engage in high-risk behavior. If use
of HT to screen sexual partners were to become widespread
in high-risk sexual networks (e.g., barebackers), it could
evolve into a community norm that could facilitate both
discussion and use of the test. Guidelines on how to discuss
HT with potential sexual partners (e.g., do it before the
actual sexual encounter, suggest mutual testing, discuss
with partner the resources available if someone tests
positive before testing) may decrease the chances of
untoward events. Furthermore, since the tactic is peer dri-
ven, it may empower individuals to take control of their
behavior, develop a non-condom-based approach for
communal, shared responsibility to prevent HIV transmis-
sion, and ultimately transform serosorting from a guessing
game into a strategy based on objective evidence.
NIMH (R01 MH79692) to Alex Carballo-Die ´guez, Ph.D., Principal
Investigator. Additional support came from the National Institute
of Mental Health to the HIV Center for Clinical and Behavioral
Studies at NY State Psychiatric Institute and Columbia University
This research was supported by a grant from
(P30-MH43520; Principal Investigator: Anke A. Ehrhardt, Ph.D.).
The authors acknowledge the support received from Dr. Ana Vent-
uneac in early stages of this project and Juan Valladares. They are
also extremely thankful to participants who volunteered their time and
candidly expressed their opinions on very intimate topics.
Creative Commons Attribution License which permits any use, dis-
tribution, and reproduction in any medium, provided the original
author(s) and the source are credited.
This article is distributed under the terms of the
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