Knowledge and use of unauthorized HIV self-test kits among men who have sex with men in Spain, following approval of an over-the-counter self-test in the U.S: a cross-sectional study

BACKGROUND Shortly after the approval of an over-the-counter HIV self-test in the US, we conducted a study to estimate the proportion of men who have sex with men (MSM) in Spain who knew that unauthorized HIV self-tests could be purchased online, and the proportion that had already used these tests, as well as their socio-demographic and behavioural correlates. METHODS Between September 2012 and February 2013, MSM users of gay dating websites were invited to complete an online questionnaire. We calculated estimates of the knowledge and use of unauthorized HIV self-testing and assessed the associated factors by rare event logit regression models. RESULTS Among 8620 participants, 4.2 % (95 % CI:3.8-4.6) knew they could buy an unauthorized HIV self-test kit online, and 12.7 % (95 % CI:12.0-13.4) thought that such a test might exist, although they had never seen one. Only 0.7 % (95 % CI:0.5-0.9) had ever self-tested. In the multivariable analysis, knowledge of online availability of self-tests was associated with being a non-Latin American foreigner, having at least two previous HIV tests, intending to test for HIV in the next year, and knowing about U.S. approval of self-testing. Ever-use of HIV self-testing was associated with being over 34 years of age, living outside Spain during the last 12 months, and knowing about U.S. approval of self-testing. CONCLUSIONS Both knowledge and use of unauthorized HIV self-testing among MSM in Spain was very low among HIV negative or untested MSM in Spain. The recent approval in the United Kingdom and France might increase the number of MSM seeking such testing and possibly using unauthorized test kits not meeting quality standards.