Who Receives HIV Testing? Exploring HIV Testing and Correlates Among Men Who Have Sex with Men in Kazakhstan

BACKGROUND AND PURPOSE: Although HIV transmission has declined globally, the epidemic in Kazakhstan has more than doubled (106%) between 2010 and 2017. Men who have sex with men (MSM) are among the most affected groups, with estimates of HIV prevalence ranging from 3.2% to 20.2%. According to the 2015 Kazakhstan Epidemiological Surveillance Data, however, less than 20% of MSM living with HIV knew their status; thus, increasing HIV testing—the first step in the HIV care continuum—among MSM is critical to reverse the trends in HIV infections in Kazakhstan. This paper aims to add to the literature by presenting HIV testing prevalence and correlates among MSM in Kazakhstan’s three populous cities: Almaty, Shymkent, and Nursultan (formerly known as Astana).

METHODS: Baseline data (N=312) from a NIDA-funded study of a social network-based intervention for increasing MSM’s engagement in the HIV care continuum in Kazakhstan were analyzed. Study eligibility requirements include the age of 18 or older, identifying as man and/or assigned male at birth, a recent (past 90 days) history of binge drinking or illicit use of a substance, and a recent (past 12 months) history of anal sex with a man. Sociodemographic characteristics, and measures of substance use and sexual risk behaviors, including condomless anal sex (CAS), were included in this analysis. Multivariate logistic regression was used to identify sociodemographic and behavioral correlates of lifetime history of HIV testing.

RESULTS: The majority of study participants were under the age of 25 (33.7%), residents of Almaty (46.5%), single (83.0%), graduates of a higher education program (79.8%), and full-time employees (51.3%). Almost all participants identified as a cisgender male (91.3%), and over half as gay/homosexual (53.8%). The majority reported a lifetime history of binge drinking (90.1%) and illicit drug use (80.4%), as well as a recent history of binge drinking (80.4%) and illicit drug use (54.5%). The mean number of male sex partners in the past 12 months was 15.71 (SD=52.57), with the majority (44.6%) reporting having six or more partners during the period. CAS with men in the past 90 days was reported by 162 (51.9%) of the participants. Most (79.8%) participants reported lifetime history of HIV testing. In multivariate analysis, being in one of the age categories over 24 years old (“25-29”: AOR=2.47, p=0.035; “30-34”: AOR=3.55, p=0.029; “>35”: AOR=3.53, p=0.006), a history of illicit drug use (AOR=2.31, p=0.023), and CAS with men in the past 90 days (AOR=0.49, p=0.029) were significantly associated with receiving an HIV test in one’s lifetime. Additionally, reporting bisexual orientation (AOR=0.53, p=0.053) was marginally associated with a lifetime history of HIV testing.

CONCLUSIONS & IMPLICATIONS: Lifetime history of HIV testing among participants in this sample was higher than those reported in the literature. Efforts are needed to ensure regular HIV testing among MSM, particularly younger MSM, in Kazakhstan. One valuable approach may be through substance use treatment; another may be through dissemination of information through those already engaged in the HIV care continuum.