HIV Testing and awareness of HIV status among people who inject drugs in greater Kuala Lumpur, Malaysia.

ABSTRACT

HIV testing services are the gateway into HIV treatment and are critical for monitoring the epidemic. HIV testing is recommended at least annually in high-risk populations, including people who inject drugs (PWID). In Malaysia, the HIV epidemic is concentrated among PWID, but their adherence to testing recommendations and the proportion of HIV-positive PWID who are aware of their status remain unknown. We recruited 460 PWID in Greater Kuala Lumpur using respondent-driven sampling and conducted HIV testing. We examined past testing behaviors, estimating testing frequency, correlates of testing in the past 12 months, and the proportion of those living with HIV who were aware of their status. Results showed that most PWID living with HIV (90.4%, 95% CI: 83.6%–95.9%) were aware of their status. Among those never previously diagnosed with HIV, few had accessed HIV testing in the past 12 months (14.3%, 95% CI: 11.1%–18.0%). Prison (57.0%) and compulsory drug detention centers (36.1%) were the primary locations where PWID reported ever being HIV tested, and the main correlate of recent testing in regression was recent criminal justice involvement. Although awareness of HIV status may be high among PWID living with HIV in Kuala Lumpur, testing occurs primarily in prisons and compulsory drug detention centers, where it is involuntary and linkage to care is limited. A shift in HIV testing policy is needed to align health and human rights objectives, replacing mandatory testing with voluntary testing in settings where individuals can be rapidly linked to HIV care.

KEYWORDS:

• HIV testing
• people who inject drugs
• Malaysia
• HIV treatment cascade

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Alexander R. Bazazi http://orcid.org/0000-0002-4284-5082

Frederick L. Altice http://orcid.org/0000-0002-7860-693X

Additional information

Funding

This work was supported by National Institutes of Health career development (FLA: National Institute on Drug Abuse [NIDA] K24DA017072, FC: National Center for Advancing Translational Sciences [NCATS] KL2 TR000140), research (FLA, AK: NIDA R01DA025943, FC: National Institute of Mental Health [NIMH] P30MH062294, National Center for Advancing Translational Sciences/BD2K 1DP2OD022614-01), and training (ARB: T32GM07205, NIDA F30DA039716) grants as well as University Malaya High Impact Research Grant Grant (AK: E-000001-20001) and the Yale Downs Fellowship (ARB). OraSure Technologies, Inc. provided discounted rapid HIV tests. Funders had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.