Abstract
BackgroundBlack men who have sex with men (MSM) in the Southeastern United States are disproportionately affected by HIV. Black MSM are more likely to have unrecognized HIV infection, suggesting that testing may occur later and/or infrequently relative to current recommendations. The objective of this qualitative study was to explore the HIV testing behaviors of Black MSM in Atlanta, Georgia, who were participants in the HIV Prevention Trials Network Brothers Study (HPTN 061).Methods and FindingsWe conducted 29 in-depth interviews and four focus groups with a community-recruited sample. Modified grounded theory methodologies were used to guide our inductive analysis, which yielded a typology comprised of four distinct HIV testing patterns. Participants could be categorized as: (1) Maintenance Testers, who tested regularly as part of routine self-care; (2) Risk-Based Testers, whose testing depended on relationship status or sexual behavior; (3) Convenience Testers, who tested irregularly depending on what testing opportunities arose; or (4) Test Avoiders, who tested infrequently and/or failed to follow up on results. We further characterized these groups with respect to age, socioeconomic factors, identity, stigma and healthcare access.ConclusionsOur findings highlight the heterogeneity of HIV testing patterns among Black MSM, and offer a framework for conceptualizing HIV testing in this group. Public health messaging must account for the diversity of Black MSM's experiences, and multiple testing approaches should be developed and utilized to maximize outreach to different types of testers.
Highlights
In the United States, Black men who have sex with men (MSM) experience disproportionately high HIV infection rates despite similar or lower rates of risky sexual behavior relative to MSM of other races [1,2,3]
Our findings highlight the heterogeneity of HIV testing patterns among Black MSM, and offer a framework for conceptualizing HIV testing in this group
These disparities are exacerbated in the Southern United States, where the relative risk of living with HIV for Black MSM is estimated to be twice as high as what has been previously reported for nationwide samples [4]
Summary
In the United States, Black men who have sex with men (MSM) experience disproportionately high HIV infection rates despite similar or lower rates of risky sexual behavior relative to MSM of other races [1,2,3]. The fact that Black MSM have higher rates of undiagnosed HIV infection notwithstanding these findings suggests that, likely to test for HIV on multiple occasions, the frequency of testing may still be sub-optimal. Another explanation for this seeming paradox is that these large-scale survey studies are somehow missing high-risk, low-frequency testers. The objective of this qualitative study was to explore the HIV testing behaviors of Black MSM in Atlanta, Georgia, who were participants in the HIV Prevention Trials Network Brothers Study (HPTN 061)
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