Changes in Sexual Risk-taking Behaviours Among Men After Participating in the PEST4MEN HIV Self-Testing Intervention in Two Fishing Communities in Central Uganda.

Abstract

Background: The availability of free HIV self-test kits in the community may alter people's sexual behaviours in some way. However, little evidence exists to confirm or refute this assertion. We assessed changes in sexual risk-taking behaviours among men living in a fishing community before and after participating in an HIV self-testing (HIVST) intervention.

Methods: This was a secondary analysis of data collected as part of a large peer-led HIVST intervention for men (PEST4MEN) in two fishing communities located in Kalangala (1) and Buvuma (1) Island districts. Following a baseline interview in July 2022, enrolled men (n=400) received oral fluid-based HIV self-test kits from their peer leaders and were followed up in September 2022 (n=361) to determine use. Data were collected on socio-demographic and behavioural characteristics using a structured questionnaire, configured in the KoboCollect tool, and loaded on mobile phones. We assessed changes in the proportion of men reporting multiple (2+) sexual partners, alcohol use before sex and condom use frequency before and after HIVST. We conducted descriptive analysis using STATA (version 14.0). Comparisons between proportions were made using Pearson's chi-square test.

Results: Of 361 men, 239 had complete HIVST and sexual behaviour data at the baseline and follow-up visits. Of these, 34.3% (n=82) were aged between 25 and 34 years with a mean age of 30.8 years (Standard Deviation: ±9.0). Fifty-six percent (n=134) were engaged in fishing or fishing-related activities. The proportion of men reporting multiple sexual partners reduced significantly from 52.3% (n=125) to 42.3% (n=101), P=.0279. However, there was a non-significant increase in condom use at last sex (from 17.2%, n=41, to 18.4%, n=44; P=.7197) and alcohol use before sex (from 10.0%, n=24, to 11.7%, n=28; P=.5568). Consistent condom use reduced somewhat between the two study visits (from 10.0%, n=24, to 8.0%, n=19; P=.4241).

Conclusion: The proportion of men reporting multiple sexual partnerships reduced significantly between the two study visits. However, this reduction was not observed in the other sexual risk behaviours. These findings suggest a need for integrating sexual risk-reduction messages into HIVST interventions in order to reduce sexual risk-taking behaviors among potential users of HIV self-test kits.