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Breaking down barriers in HIV testing

Gay and bisexual men can have a ‘pint and a prick’ on their nights out thanks to a programme that has been breaking down barriers to HIV testing in cities across Ireland for over two years.

The KnowNow rapid HIV testing programme brings the simple finger-prick test to places where gay and bisexual men frequent and feel comfortable in and aims to ensure getting tested for HIV is as simple, accessible and convenient as possible. The peer-led, community-based free testing service delivers a result in 60 seconds, eliminating the stress of waiting a week or more in many other settings.

“We want to remove as many barriers as we can to HIV testing and normalise the whole experience. We looked at the novel approach of community-based rapid HIV testing that has been adopted by other big cities around the world and felt it was something that we could deliver in Irish cities too.

From very early on, it was accepted by the gay and bisexual community and continues to be a successful low threshold testing opportunity. It has been brilliant in giving people access to testing that may not feel comfortable accessing clinical services,” explained Adam Shanley, Co-ordinator of the KnowNow programme.

“We offer tests in non-clinical settings such as bars, clubs, saunas and other community settings to men who have sex with men. We only ask the need-to-know questions and the depth of conversation between peers will depend on how much the person wants to share.

The primary aim is to empower people with knowledge of their HIV status but in addition, it’s a really great opportunity to offer peer support and information on sexual health and wellbeing more generally.”

Pantibar on Dublin’s Capel Street is the flagship location in the programme, which also operates in other venues in the capital, as well as in Galway, Limerick and Cork. Adam highlighted the importance of the peers who help deliver the service in the various locations.

“We have gay and bisexual men fully trained in all aspects of delivering rapid HIV testing and equip volunteers with the skills they need to offer support and information,” he explained.

“The process for the test is that service users come in and register with the team. We just take some non-identifiable statistical information to protect anonymity, which is important to some. When it’s their turn, they sit with the peer and that person will chat with them and ask them some open-ended questions in order to assess whether or not it is the right time and place for them to test. It’s also an opportunity to fill any gaps in knowledge and ultimately gain informed consent to test.”

He stressed that people are not made to feel coerced when they are out to relax and enjoy themselves on a Saturday evening. “We let patrons of the venues in which we test know that we’re available by dropping flyers on the tables. Some are opportunistic testers and sign-up because they happen to be there, while others have seen online advertising on social media or dating apps and make the effort to come along.”

“We have private areas in all venues in which we carry out testing. In Pantibar, for example, there are two floors. There is the main bar on the top and we have the whole bottom floor to ourselves throughout the session. We also only test two people at a time so privacy is maintained at all times,” said Adam.

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The test itself is simple. It is a finger prick test like you would take to test for blood sugar in a diabetic. In just 60 seconds you have your result. If there are two blues dots, then that test has flagged a potential antibody response and further testing is needed.

“If the results are reactive, then we explain that it is an indication of HIV status and that a confirmatory blood test in a clinical setting may be needed. We have built very strong referral pathways. In Dublin, reactive results in our Tuesday or Wednesday services see users immediately sent to the Gay Men’s Health Service for confirmatory testing. Similarly, testing in Limerick, Cork and Galway have built relationships with their local hospitals to facilitate follow-up.

The whole referral pathway is solid and that is vital. If the preliminary test is reactive, then it is important not to leave somebody waiting for a proper diagnosis” he said. “The role of the peer and their training is so important when delivering a reactive test result.

A person’s reaction to the test result depends very much on what kind of result they were expecting. Many men who have sex with men have a good understanding of how the virus is transmitted and can recognise when they have put themselves at risk, in these situations some have begun preparing themselves for a potential reactive result.

“But sometimes, it’s a shock and people are not ready for the result. That’s why we rely on a well-trained peer to be able to offer them the support that they might need in that moment and have the up-to-date knowledge about what living with HIV means. It’s also why the pre-test chat is so important. The person getting tested needs to be in a frame of mind to be able to receive a result. The peer may decide with the person being tested that maybe it isn’t the right time, or place or that the service user needs more support than what a peer can offer – and wecan arrange to make that so.”

The programme also uses the test to provide information to gay and bisexual men about how to reduce their vulnerability to HIV and other STIs and to encourage them to make testing a regular part of their routine.

“HIV is built up as ‘the big one’ for many and the one that people are most anxious about. When we deliver negative results, then it is a good time to be encouraging them in seeking a full STI screen and to consider making testing part of their regular routine,” said Adam.

In Dublin, the programme is currently testing between 150 and 300 people per month, averaging around 60 a week. Last year, of all those who received reactive results, 50% were first-time testers.

“It is important that people are testing regularly to ensure that they are not unknowingly transmitting the infection to their sexual partners. We recommend that men who have sex with men get tested every three months as routine or six weeks after a high risk event. The sooner someone is tested, diagnosed and on treatment to supress the virus, the faster we will achieve a break in the cycle of new infections,” he said.

For more see https://www.sexualwellbeing.ie/sexual-health/sexually-transmitted-infections/information-on-hiv/ and http://www.knownow.ie/