Background: HIV self-testing is an important strategy to expand HIV testing among risk populations particularly those hesitant to come to the clinic for HIV testing. Men who purchase sex are a key population for HIV prevention, but no studies have explored the acceptability and uptake of self-testing in this group.
Methods: In December 2017- January 2018, men attending seven brothels in Bali Indonesia were invited to a general health survey, and once they completed the survey, were offered a HIV self-test. In accepting the test, men could opt to conduct their test off-site or on-site at the brothel (with partial or full supervision). Men were also asked to complete a follow up survey on their views of HIV self-testing.
Results: Among the men approached, 292 completed the health survey; only 12.7% reported a HIV test in the past. A high proportion (64.7%, n=189) of the men who participated in the health survey agreed to have a HIV self-test. Nearly all men (98.4%, n-186), requested to have a HIV self-test on-site and 3 (1.6%) off-site. Of those testing on-site, 156 (83.9%) preferred full supervision including when reading their results, and 30 (16.1%) partially assistance without supervision when reading their results. Of the HIV self-tests done, 4 men (2.1%) had a reactive result. Two thirds (75.1%) of those who completed the follow up survey said there was nothing they did not like about the test; and 77.5% trusted the result.
Conclusions: This is the first international study among men who purchase sex involving HIV self-tests distributed by lay workers in brothels. The study shows the testing model was acceptable among the men and increased HIV testing rates by more than 5 times compared to baseline levels. Most men preferred assistance when conducting the HIV self-test, and trained lay workers were able to provide this support.