Influence of anonymous HIV testing on national HIV surveillance in the Republic of Korea (2000 to 2015): a retrospective analysis

Background Owing to the continuous increase in the number of new human immunodeficiency virus (HIV) infection in Korea, public health centers (PHCs) have performed anonymous tests since 1989. No study has examined the patterns of anonymous HIV testing performed at PHCs and the characteristics of HIV infection detected in those tests. We aimed to assess the influence of anonymous HIV testing on Korea’s national HIV surveillance. Methods HIV screening test data from 253 PHCs over a 16-year period were classified into 13 groups based on reason for testing. For anonymous HIV test takers (Anonymous), the HIV positivity per 10,000 tests was calculated, as repetitions could not be distinguished. Those with suspected HIV infection voluntarily underwent HIV testing and revealed their identity (Suspected). HIV prevalence was calculated as the number of HIV-positive persons per 10,000 test takers. Analyses were performed using chi-square and Cochran-Armitage trend test with SAS 9.4. Results Approximately 400,000 HIV screening tests were performed at PHCs annually, which remained unchanged in the past 10 years. The proportion of anonymous testing increased from < 3.0% before 2014 to 4.8% in 2014 and 6.1% in 2015. While the number of HIV cases increased, the number of anonymous HIV-positive test results per 10,000 tests decreased from 68.8 in 2010 to 41.8 in 2015. The HIV prevalence among the suspected was approximately 20.0 per 10,000 test takers before 2014, which steeply increased to 71.6 in 2015. Those with suspected HIV were predominantly men, aged 20 years, foreigners, and metropolitan city dwellers in the last 6 years. The high prevalence of persons with suspected HIV resulted in a doubling of HIV prevalence at PHCs between 2014 and 2015. Conclusions Anonymous and Suspected, which were driven by similar motives, impacted each other. Increase in HIV prevalence among the suspected led to a higher HIV prevalence among all test takers in PHCs and higher proportions of HIV infection nationwide, which could be attributed to the increase in the number of anonymous tests performed in PHCs. HIV positivity among the anonymous and HIV prevalence among the suspected are key indexes of the national HIV surveillance in Korea.

Violence and Discrimination Against Men Who Have Sex With Men in Lebanon: The Role of International Displacement and Migration

Homosexuality is illegal in Lebanon and men who have sex with men (MSM) may experience discrimination. Displaced Syrians, who currently comprise approximately 20% of Lebanon’s population, also face discrimination. Individuals who are members of both groups may experience heightened levels of discrimination and abuse. In partnership with local nongovernmental organizations serving the community, we recruited N = 292 MSM in Beirut, Lebanon. Participants were interviewed about experiences of violence and discrimination in the context of a larger health behavior survey, and all were offered anonymous HIV testing. Responses were analyzed using the framework of intersectionality, combining regression, geographical mapping of reported experiences, and network analysis of the participant recruitment pattern. MSM, born outside of Lebanon, who are primarily from Syria, face higher levels of discrimination and violence than native-born MSM (71% vs. 32% reporting at least one type of discrimination or violence). Socioeconomic status is also associated with discrimination and violence overall, and among native- and foreign-born MSM. Experiences vary by town and neighborhood, and are highly correlated between recruiting and recruited participants.These results highlight health risks faced by foreign-born MSM in Lebanon.

Increasing awareness and prompting HIV testing: Contributions of Amsterdam HIV Testing Week 2016

We evaluated Amsterdam HIV Testing Week (HTW) 2016 regarding its primary goals of raising awareness and prompting HIV testing. Participating services offered free, anonymous HIV testing, with a focus on reaching men who have sex with men (MSM) and people with a non-western migration background. Sociodemographic characteristics, HIV testing history, intention to test regularly, beliefs about personal risk and severity of HIV, and perceived social norms regarding HIV testing and people living with HIV were assessed among all who tested. A community quick scan assessed awareness of Amsterdam HTW 2016 and attitudes and intentions regarding HIV testing. Of 806 people tested, 59.6% (405/679) belonged to key populations. None tested HIV-positive and 37.6% intended to test regularly in the future. The community quick scan found moderate awareness of Amsterdam HTW 2016. Awareness was highest among recent testers and HIV-positive MSM and not associated with HIV testing attitudes and intentions. People tested during Amsterdam HTW 2016 were from key populations and/or were not (adequately) reached via traditional testing approaches. The contribution of the Amsterdam HTW approach to raising awareness and prompting HIV testing in key populations may benefit from focusing on HIV-negative individuals who have not been tested recently.

Resisting Public Health Surveillance: Anonymous HIV Testing and the Imperative of Health

To date, there has been little research published about public health surveillance and HIV testing/prevention. Accordingly, an exploratory project was undertaken, involving a detailed review of local public health law, and the distribution of surveys about self-reported STI testing/diagnosis, HIV testing practices, and sexual behaviours among gay, bisexual, and other men who have sex with men. A review of the public health law indicated that, in the local context, there is a pervasive public health surveillance apparatus that requires mandatory reporting of identified communicable diseases, including HIV. Results of the survey indicated that individuals who reported a preference for, or use of, anonymous HIV testing were more likely to have reported having (a) been tested for, and diagnosed with, STIs, (b) a self-reported history of anal sex, (c) more sexual partners, and (d) been aware of criminal prosecutions against people living with HIV for not disclosing their HIV status. At first glance, it appeared as though anonymous HIV testing represented a form of resistance to public health surveillance; a strategy by which individuals who are likely to test positive for HIV circumvent surveillance. However, when these results were examined using Lupton’s “Imperative of Health” framework, it became clear that one must appreciate the two-pronged nature of anonymous HIV testing. On the one hand, knowing one’s HIV status can be beneficial; for example, it corresponds with decreased HIV transmission and improved quantity / quality of life for people living with HIV. On the other hand, anonymous testing represents a complicit acceptance of the imperative of health, and an internalization of public health surveillance. From this perspective, true resistance to public health surveillance would manifest as an absolute rejection of HIV testing.