Screening at an alternative clinic without disclosing

Six of the 283 men with diagnosed HIV did not respond to the question about STI screening at an alternative clinic without disclosure. Of the remaining 277, 26 (9.4%) indicated that they had ever had an STI screen at a service other than their usual HIV care provider without disclosing their diagnosed HIV infection. Of these 26 men, 8 reported having done so in the last 12 months, 7 between 1 and 5 years ago and 2 over 5 years ago. Nine did not respond to the question on recency. So, of the 9.4% of men who had ever sought anonymous screening, 47% had done so in the last year or approximately 4.4% of surveyed men with diagnosed HIV.

HIV testing

On their last occasion of STI screening away from their usual provider where they did not disclose their HIV infection, 4 of the 26 reported having an HIV test, 18 reported not having one and 4 could not remember or did not know whether they had.

Benefits and costs of STI screening at an alternative clinic without disclosure

Respondents were asked about the benefits of attending an alternative service for STI screening. Of the 23 who responded, 10 reported either ‘none’ or ‘don't know’. Convenience was mentioned as a benefit by six who reported that an alternative service was easier to use as it provided a walk-in clinic, a swifter service, was open at weekends or was conveniently located. One man said that it was easier to attend his HIV clinic (without explaining why he used an alternative service) and one responded ‘to keep up to date’, presumably with his STI status.

The remaining six respondents mentioned confidentiality, privacy, the avoidance of stigma and averting discussion of their sexual practices with their HIV care provider as benefits of using another service. One explained, ‘The relationship with HIV clinic staff is ongoing and I want to avoid the embarrassment of STI screening therefore I seek a more anonymous service.’ Another was more explicit, reporting that attending another service allowed him to ‘avoid discussion about frequency/nature of sexual activity with [his] HIV doctor/nurse’. A possible reason for wanting to avoid such a discussion was provided by another man who explained that attending for STI screening away from his usual care provider avoids ‘blame culture’, suggesting that he feared reprimand.

Regarding the disadvantages of STI screening away from their usual HIV care provider, 8 of the 21 who responded to this question thought that there were none or could not identify any. Five reported being inconvenienced by the time taken, distance travelled, transport costs or the cost of tests (one mentioned paying £180 to a private clinic). One added that ‘they [staff at the service] try to pressure you to have an HIV test’.

Eight men saw the resulting lack of continuity in their care as a disadvantage. In contrast to responses to the question about the benefits of keeping information from their usual sexual health service by going elsewhere, these men saw this sequestering of information as detrimental to their care. The fact that information was not shared across services meant that ‘the individual has to go through their history with someone new again and again if they use more than one clinic which can be annoying and time wasting’. Concern was expressed that a regular provider was ignorant of the ‘full picture’ and that having no history with a clinic made it ‘difficult to track possible issues with medication especially immunity to some medication which results in treatments not working’. Two men who reported the benefits of attending a clinic away from their usual provider as lack of stigma and avoidance of an uncomfortable discussion thought the cost was the loss of continuity of care.