Regular HIV prevention counselling reduces risk of infection

Dr Wipas Wimonsate at HIVR4P
"Foundation of HIV prevention is infact HIV testing" said Dr Anthony Fauci of National Institutes of Health at the opening plenary (via video link) of the HIV Research for Prevention (HIVR4P). But mobilizing people to go for voluntary and repeated counselling and testing for HIV has indeed been a challenge. It is even a steeper challenge to mobilize key populations such as men who have sex with men (MSM) to go for HIV testing repeatedly.

There are two case studies from Thailand: first case study looked at very innovative ways to mobilize people, particularly MSM, to opt for testing and repeat test regularly. The other case study looked at a large number of MSM people over a period of many years on whether regular HIV counselling and testing had an impact on HIV risk reduction?

Test BKK
Asia Pacific Coalition on Male Sexual Health (APCOM) has recently launched the second phase of their innovative City-Based HIV testing campaign, TestBKK, which encourages gay men in particular to get tested every three to six months. Using TestBKK the highly engaging tagline: “Suck F*#K Test Repeat.” It aims to normalise HIV testing among young gay men and make it a regular part of their health routine. The campaign emphasizes the importance of knowing one’s HIV status, and the website reads, “casual disregard for HIV does not make the disease go away.”

Test BKK uses light-hearted, often humorous videos, with the message: “There are more awkward things than getting tested.” and “Afraid of things you have done in your past? Knowing is better than not knowing." The first, which shows a young man masturbating to a sex video, before his family bursts into the room yelling “Surprise, happy birthday,” much to the young man’s horror, has received more than half a million YouTube views.

“TestBKK is designed to direct MSM to supportive clinics called ‘Premium Testing Services', and to send the message, “Don’t be afraid,” said Midnight Poonkasetwattana, Executive Director, APCOM. “The campaign encourages young men to attend testing sites that will be respectful and sensitive to their lifestyles and orientation,” he said. APCOM’s TestBKK plans to roll out the campaign in other Asian cities, including Ho Chi Minh City, Jakarta and Manila.

MoPH-CDC Thai study
Study results from Thailand emphasize the need to continuously encourage people to practice safe sex and regularly access the comprehensive HIV testing services in order to prevent HIV acquisition. Wipas Wimonsate from Ministry of Public Health and Centers for Disease Control and Prevention (CDC) Collaboration in Thailand presented the study results at the HIV Research for Prevention (HIVR4P) conference in Cape Town. He said that multiple HIV counselling sessions to encourage safe sex practices helped men who have sex with men (MSM) in Bangkok stay HIV-uninfected.

1260 MSM were enrolled in April 2006 for this study and followed up until March 2014 at the Silom Community Clinic @TropMed. This follow up is still ongoing. Most of the study participants were between 22-29 years old at the time of enrollment. They had a maximum of 16 study visits with a mean of 11 and a standard deviation of 5. Among 1260 MSM participants, 239 of them acquired HIV.

At every visit, the participants received comprehensive HIV testing services which included: provision of condoms and lubricants, HIV testing, symptomatic testing and treatment of sexually transmitted infections (STIs), CDC recommended pre/post HIV test counselling and HIV information and risk reduction counselling. “We found that HIV incidence among our participants was associated with being young, using drug for sexual pleasure, inconsistent condom use, practicing receptive anal sex, engaging in group sex, and diagnosis with syphilis infection at time of enrollment” said Wimonsate to Citizen News Service (CNS).

He added that “data shows that HIV incidence was not statistically significantly different by year of follow-up. This means that participants in the study could be found with seroconversion at any point in the study, even among those with higher number of visits. Therefore, being HIV uninfected was not a prerequisite for having a higher number of visits.

Chances of remaining HIV uninfected were 1.3 times higher for each subsequent visit. Remaining HIV uninfected was also associated with practicing only insertive sex, using condom consistently, and abstaining from participating in group sex.” One limitation of the study Wimonsate pointed out was that MSM participants came from urban areas of Thailand and perhaps larger studies may be needed to generalize results across the country.

“More visits to healthcare centres and safe sex practices were independently associated with remaining HIV uninfected, regardless of other baseline demographic factors such as having sexually transmitted infections (STIs) and other behavioral factors. It remains unclear why MSM with greater number of visits were more likely to remain HIV uninfected, although some studies reported that HIV counselling has a moderate and significant effect on increasing protected sex among urban MSM.”

Bobby Ramakant, Citizen News Service - CNS
29 October 2014