Self-testing to reach transgender women and gay men in Myanmar welcomed
Trans women and gay men in Myanmar experience stigma and discrimination making them unlikely to access HIV services – HIV self-testing can help fill the HIV testing gap.
HIV self-testing has the potential to increase testing and early diagnosis among transgender women and men who have sex with men in Myanmar – of which less than 50% have a history of HIV testing.
The study, by the Johns Hopkins University School of Public Health and the International HIV/AIDS Alliance in Myanmar, conducted focus groups and in-depth interviews with transgender women and men who have sex with men to assess the acceptability of HIV self-testing among these groups.
The confidentiality and privacy offered by self-testing were widely identified as benefits by both populations, whose access to HIV services is currently hampered by extensive stigma and discrimination. Many participants cited the potential of self-testing to prevent family, neighbours and others from finding out about their sexuality or HIV status as a distinct advantage.
Myanmar’s HIV epidemic is concentrated among transgender women and men who have sex with men and the study, which was published in April 2017, comes at a time when its National HIV Strategy is focused on curbing new HIV infections among these groups.
According to the country’s National AIDS Programme, less than half of transgender women and men who have sex with men report any history of HIV testing. As a result, in 2015 transgender women and men who have sex with men had an estimated combined HIV prevalence of 11.6% nationally, reaching 26.6% in Yangon, Myanmar’s largest city.
People taking part in the study saw self-testing as a way to avoid uncertainty and worry about who may be present when seeking facility-based HIV testing. Self-testing was also seen as more convenient as it can be done at home. The fact that self-testing is conducted through a saliva-based test and is therefore pain free was also seen as an advantage.
Although participants were generally optimistic about the advantages of self-testing, certain concerns were raised, particularly around the lack of counselling associated with self-testing. Participants feared this might lead to poor mental health outcomes among those who test positive for HIV, which could prevent them from disclosing their status and accessing HIV care. As a result, the study describes the provision of some form of HIV counselling alongside self-testing, particularly for those with preliminary positive HIV results, to be of “salient importance” should HIV self-testing be implemented in Myanmar.
The fact that self-testing is conduced orally also raised concerns. Participants highlighted how this may lead people to incorrectly believe that saliva can transmit HIV, which has the potential to further stigmatise people living with HIV. The use of community education, peer networks, social media and mass media to inform transgender women and men who have sex with men about self-testing was suggested by participants as a way to tackle this.
Concerns around employers or others in positions of power introducing compulsory self-testing, which could result in further HIV-related stigmatisation, were also raised and must be taken into consideration.
The new research is released just before the International Day against Homophobia, Transphobia and Biphobia (IDAHOT), a worldwide celebration of sexual and gender diversity, celebrated annually on 17 May.