Has testing been normalized? An analysis of changes in barriers to HIV testing among men who have sex with men between 2000 and 2010 in Scotland, UK

P Flowers,C Knussen,J Li,L Mcdaid

doi:10.1111/j.1468-1293.2012.01041.x

P Flowers, C Knussen + Show 2 more

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https://doi.org/10.1111/j.1468-1293.2012.01041.x

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Abstract

ObjectivesThis paper examines changes in barriers to HIV testing amongst gay men. We compared data collected in 2000 and 2010 to assess changes in HIV testing behaviours, in community-level perceptions of barriers to HIV testing, and in the relative contributions of barrier measures.MethodsCross-sectional surveys were conducted within the commercial gay scene in Glasgow with good response rates (78% and 62%) using a form of time and location sampling.ResultsMajor changes in HIV testing behaviours were observed between 2000 and 2010 (30.6% increase in testing within previous year). At the community level, the perceived benefits of testing [t (1284) = –8.46; P < 0.001] and the norm for HIV testing [t (1236) = –11.62; P < 0.001] increased; however, other perceived barriers did not change (fear of a positive result, clinic-related barriers and attitudes to sex with HIV-positive men). Multinomial logistic regression showed that fear of a positive test result remained a key barrier to HIV testing; however, a significant fear × year of survey interaction indicated that fear played a lesser role in differentiating those who had never been tested from those who had been tested in 2010 than it had in 2000.ConclusionsThese findings suggest the partial normalization of HIV testing. While some barriers have reduced, other key barriers remain important. Interventions should be designed and evaluated that attend to both the biomedical and the psychosocial aspects of HIV testing (e.g. the meaning of positive test results, the sexual exclusion of positive men, and HIV-related stigma).

Highlights

While across Europe HIV prevention policies differ [1], increasing both the number and frequency of HIV antibody tests amongst men who have sex with men (MSM) remains central to attempts to normalize HIV testing, reduce undiagnosed HIV infection, prevent new HIV infections and decrease HIV-related morbidity [2,3]
The shift in HIV testing policy in the UK from optin to opt-out testing [12] has been associated with unprecedented increases in testing at the community level [13,14], a drop in undiagnosed HIV infection [15], and
At the level of the patient or client, the key barriers appear to be low risk perception, fear of HIV disease, fear of HIV disclosure, and the accessibility of health services. In addition to these barriers, De Wit and Adam [20] identified the importance of the perceived benefits of testing, which they suggest are rarely concerned with antiretroviral therapy (ART)

Summary

Introduction

While across Europe HIV prevention policies differ [1], increasing both the number and frequency of HIV antibody tests amongst men who have sex with men (MSM) remains central to attempts to normalize HIV testing, reduce undiagnosed HIV infection, prevent new HIV infections and decrease HIV-related morbidity [2,3]. At the level of the patient or client, the key barriers appear to be low risk perception, fear of HIV disease (and fear of the consequences of a positive test result), fear of HIV disclosure (including discrimination and rejection), and the accessibility of health services. In addition to these barriers, De Wit and Adam [20] identified the importance of the perceived benefits of testing, which they suggest are rarely concerned with antiretroviral therapy (ART). The importance of patient-related barriers such as lack of perceived risk, a lack of information regarding testing possibilities, stigmatization and fear of a positive test result have been highlighted [22]

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