How mystery shoppers can improve HIV testing services

National HIV Testing Day is an annual event emphasizing the importance of HIV testing.
Research has shown that young sexual minority men (YSMM) and other sexual and gender minority populations are more motivated to engage in HIV testing services if they are high-quality, affirming, and tailored to their needs. However, there is a limited understanding of YSMM’s experiences when they visit HIV/STI prevention clinics. ATN researchers sought to change that through the Get Connected study, which took place from 2017-2021.

What were mystery shoppers?

The first phase of the Get Connected study explored an innovative “mystery shopper” strategy to evaluate YSMM’s experiences receiving HIV testing. Traditionally, mystery shopping is where a trained professional anonymously visits a retail store or a restaurant. This strategy is not as common in healthcare settings, like clinics offering HIV counseling, testing, and referral (CTR) services. Get Connected engaged 24 YSMM to conduct mystery shopper visits at over 60 testing sites in Atlanta, Houston, and Philadelphia. These mystery shoppers assessed the quality of HIV/STI prevention services, such as cultural responsiveness in working with YSMM.

Cultural responsiveness in clinics offering CTR services involves: 

– The clinic’s environment displaying LGBTQ-affirming imagery

– Medical forms using inclusive and affirming language

– Counseling on safer sex strategies that does not stigmatize a person’s sexuality or gender identity – Discussions addressing client’s sexual and romantic relationships

Insights and improvements for HIV testing sites

The data from mystery shopper reviews showed that most testing sites were seen as welcoming, respectful of privacy, and confidentiality. But, there’s room for improvement in how well providers understand and serve YSMM, and in making clients feel comfortable during their visits. Additionally, there’s inconsistency in providing information and counseling about PrEP at different sites, highlighting a gap in comprehensive preventive care.

To address this, the Get Connected web app used mystery shopper data to match participants with HIV/STI testing services that offer comprehensive and culturally responsive care. The Get Connected trial, which enrolled 285 YSMM, found that 40.0% of participants tested at least twice for HIV, and 32% tested twice for STIs, surpassing the 20%-37% testing rates reported in previous literature. The results indicate the effectiveness of the intervention in promoting regular testing among YSMM.

The importance of providing culturally responsive HIV testing services

To conclude, the first HIV test often serves as an individual’s introduction to prevention services. Ensuring this experience is high quality, culturally, and developmentally appropriate is crucial to continual engagement in healthcare. Positive initial encounters with HIV testing can instill confidence in taking charge of your healthcare, particularly among YSMM and other sexual and gender minority populations. “On National HIV Testing Day, we celebrate the importance of culturally competent care for young sexual and gender minorities,” remarks Dr. José Bauermeister (he/him), Get Connected Protocol Co-Chair, and ATN co-lead of the Assets, Resources, Challenges, and Context Scientific Leadership Group. “Service quality matters to young people and is linked to HIV/STI testing service utilization. We must continue to test and scale programs that can help improve access to quality HIV/STI testing services.”