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Vending machines can get STI tests to more people, U.K. study suggests

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In at least two British cities, certain vending machines offer up not snacks and sodas but a more unusual item: free self-test kits for sexually transmitted diseases.

The initiative aims to overcome some of the obstacles that keep people from testing: the hassle of going to the doctor, the stigma of visiting sexual health clinics (especially for LGBTQ+ people who are not out) and a lack of awareness about testing options. Such obstacles contribute to more than a million STIs being acquired globally every day, according to the World Health Organization, which has called for better access to testing and diagnostic services.

A study of the vending machines’ effectiveness published this month found that more than half of their users said it was their first STI test. Spearheaded by the Brighton and Sussex Medical School and developed by the Martin Fisher Foundation, the vending machines can be found at more than 10 locations in the Bristol and Brighton regions.

“What we found with all of the machines is that actually people see these things, and they think, ‘you know what, it’s fine, I’ll use it,’ and then it starts normalizing testing,” said Jaime Vera, a professor of HIV Medicine at the Brighton and Sussex Medical School who led the project.

In the United States, more than 2.5 million cases of syphilis, gonorrhea, and chlamydia were reported in 2022, according to the Centers for Disease Control and Prevention, a number that has been relatively stable for years. Syphilis, especially congenital syphilis (transmitted during pregnancy), has grown significantly in recent years.

U.S. syphilis numbers are at their highest since the 1950s, CDC report says

STI rates generally rose 24 percent in England the same year, with gonorrhea cases increasing by 50 percent from the previous year, according to analysis of U.K. Health Security Agency data by the Terrence Higgins Trust. Chlamydia and gonorrhea cases have sharply increased across the European Union, according to the European Center for Disease Prevention and Control in December.

Testing is an important part of reducing the spread of STIs because people have to know they have an STI to get treated and potentially avoid spreading it to others, according to Nicholas Medland, a past president of the Australasian Society of HIV, Sexual Health and Viral Hepatitis Medicine who is now with the University of New South Wales Kirby Institute.

The British government recommends at least annual STI and HIV testing, calling regular screening “essential to maintain good sexual health.”

Many common STIs, including syphilis, gonorrhea and chlamydia, are curable. HIV/AIDS, once an often fatal condition, can now be controlled with treatment especially when caught early.

Medland believes vending machine tests should be made available as a supplement to existing services, but added they “should not be used as a substitute for clinics, and not as a justification to cut clinic funding.”

Jeffrey Klausner, professor of clinical population and public health sciences at the Keck School of Medicine of the University of Southern California, cautioned that such an approach may be less likely to work at scale in the United States, which has a very different health-care environment than the United Kingdom’s publicly funded universal system.

“It’s going to depend on who’s paying for it,” he said. He added that a similar study he led of HIV test kits in vending machines in Los Angeles, published in 2018, found less than half of people who returned a positive result followed up with treatment within the study’s time frame.

The U.K. study measured only testing uptake, not treatment, but its authors concluded that the vending machines were an effective means of reaching infrequent or “never” testers.

More than 2,500 self-test kits were dispensed in the course of a year from vending machines at locations including shopping malls, a library, community centers, doctor’s clinics, a university campus and a commercial sex venue. A survey was completed by 208 users.

The vending machines offered both self-test kits for HIV, which can be completed at home with a result within 20 minutes, and tests for chlamydia, gonorrhea and syphilis as well as HIV that must be placed into a pre-filled envelope and mailed to a clinic for results.

Since putting the first machine in place in Brighton, the medical school has also worked with partners in Zambia, Japan and Jamaica, Vera said.

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