Surprising Reasons Why Gay Men Avoid HIV Testing

Inconvenience and Personal Risk Perception Often Cited as Key Barriers

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It has long been assumed that the fear of disclosure or the inability to cope with an HIV diagnosis was at the heart of why many gay and bisexual men avoid HIV testing. And while these do remain significant concerns, there a number of other key barriers to the testing among those in this high-risk population, which accounts for 30% of all new infections in the U.S. and over 70% of infections among persons aged 13-24.

According to research from the Sydney Rapid Test Study, of the 1,046 gay or bisexual men surveyed, only 4.3% reported having no barriers to HIV testing. The remaining 95.7% listed one or more such barriers, often contradictory in nature but illustrative of the complex social, functional and psychological issues related to HIV testing.

Study Design

The study participants, the majority of whom were aged 18 to 44, were almost equally split between those living in suburbs with other gay male residents (56%) and those with few gay male residents (44%). Similarly, just over half (57%) reported having had sex with a regular male partner.

In terms of inclusion, gay or bisexual men considered to be of low risk of HIV were excluded from the study. Of those recruited, 67% reported having an open relationship; 59.6% had two to 10 sex partners; and 39.9% reported using condoms "sometimes" or "never: during anal intercourse.

Overall, 89.9% had been previously tested for HIV, with 72.4% of these having been tested in the past 12 months.

The study was conducted in four government-funded sexual health clinics in Sydney, with no financial incentive provided for participation.

Survey Results

Strangely enough, convenience ranked as one of the main barriers to HIV testing, with "It’s annoying to have to return for results" being the top complaint among respondents.

Fear of testing, unsurprisingly, was of greater concern to those who had never tested (40.2%) as opposed to those had been previously tested (26%).

Simple squeamishness also figured in, with needles and blood being a far bigger concern among participants than issues relating disclosure or stigma, which at least for this study population seemed relatively low.

Barriers to More Frequent HIV Testing by Test Status

BarrierTotalNever
Tested
Previously
Tested
It’s annoying to have to return30.2%20.5%31.3%
I haven’t done anything risky29.6%28.6%29.8%
It’s stressful waiting for the the test result28.4%23.2%29%
I’m scared of a positive result27.5%40.2%26%
I have been tested recently23.2%0%25.9%
It’s difficult to find the time to be tested20.6%17%21%
I don't like needles/syringes9.5%14.3%9%
I don’t like having blood taken for the test5.9%10.7%5.3%
It’s difficult to get an appointment4.5%1.8%4.8%
I don’t like to show my Medicaid card3.4%2.7%3.5%

Considerations and Contradictions

Beyond the variations in response from the never tested and previouly groups, there were some concerning contradictions in the findings, particularly looking at risk behaviors and gay self-identification.

For example, men who reported having 10 or more sex partners were the most likely to complain having to return for results, while nearly a quarter of these (24.8%) believed themselves to be of low risk for infection. Similarly, 26.4% of those who have had condomless anal sex also perceive themselves to be as lesser risk.

One interesting point was that "out" gay men were far more likely to consider testing burdensome (either because they had been tested recently or found it difficult to find the time) than those who were not  gay-identified.

By contrast, men who didn't identify as gay had significantly greater fear of a positive result and were five times more likely to be concerned about presenting their Medicaid card. The fact that one fear plays into another—wherein a positive result might reveal a man to have had sex with another man—highlights the greater need for targeted intervention for this at-risk group.

The same appears to be true for gay or bisexual men under the age of 25, who are more likely to fear a positive result than their older counterparts (36.7% vs. 25.1%) and appear to be more squeamish about blood tests in general (12.8% vs. 8.7%). Overcoming these and other barriers—through targeted outreach or a provision for HIV self-testing—may help improve uptake among one of the most vulnerable (and under-tested) HIV populations.

Sources:

Centers for Disease Control and Prevention. "HIV Among Gay and Bisexual Men." Atlanta, Georgia; accessed September 17, 2015.

Conway, D.; Holt, M.; Couldwell, D.; et al. "Barriers to HIV testing and characteristics associated with never testing among gay and bisexual men attending sexual health clinics in Sydney." Journal of the International AIDS Society. August 27, 2015; 18:20221; DOI: 10.7448/IAS.18.1.20221

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