Abstract
Testing is the entry point into the HIV care continuum that includes linkage to and retention in prevention services, and adherence to prevention strategies, including repeat HIV testing. Despite US policy approaches to expand HIV testing to diverse clinical care and community settings, disparities in HIV testing among Black populations persist. Foreign-born (FB) Black persons from the Caribbean have higher annual rates of HIV diagnosis and a higher percentage of late-stage HIV diagnosis, compared with US-born Black persons; and most HIV infections among FB Blacks are among men. In this article, we provide an overview of HIV testing barriers among FB Black men who engage in HIV risk-taking behaviors (e.g., condomless sex with male and/or female partners of unknown HIV serostatus). Barriers to HIV testing for both FB and US-born Black men, include HIV stigma (anticipated, perceived, internalized), low perceived HIV risk, medical or government mistrust, and perceived low access to testing resources. We examine beliefs about masculinity and gender roles that may perpetuate heteronormative stereotypes associated with perceptions of low HIV risk and barriers to HIV testing. We also discuss the impact of recent immigration policies on accessing HIV testing and treatment services and how intersectional stigmas and structural forms of oppression, such as racism, prejudice against select immigrant groups, and homophobia that may further amplify barriers to HIV testing among FB Black men. Finally, we review comprehensive prevention approaches, and suggest innovative approaches, that may improve the uptake of HIV testing among FB Black men.
Highlights
In the United States (US), foreign-born (FB) persons, defined as individuals who were born outside the continental US and its territories, and naturalized citizens, comprise only 13% of the country’s population, yet FB individuals face barriers to accessing health care that may lead to poorer HIV disease outcomes [1, 2]
One study found that conspiracy beliefs related to pre-exposure prophylaxis (PrEP) were reported more frequently among Black men and transgender women who have sex with men compared to their White counterparts, and that there is an urgent need to address racial medical mistrust so that individuals at risk will understand the potential benefits of PrEP, a highly effective biomedical strategy for HIV prevention [151]
Known barriers to HIV testing, such as perceived, anticipated, internalized HIV stigma, low perceived risk, endorsing HIV conspiracy beliefs, and perceived low access to testing are common among FB Blacks
Summary
In the United States (US), foreign-born (FB) persons, defined as individuals who were born outside the continental US and its territories, and naturalized citizens, comprise only 13% of the country’s population, yet FB individuals face barriers to accessing health care that may lead to poorer HIV disease outcomes [1, 2]. The UNAIDS, WHO, and the US through the National HIV/AIDS Strategy have set goals for 2020 to improve diagnosis rates among people living with HIV (PLWH), initiate therapy, and achieve viral suppression; all include the goal of having 90% of PLWH aware of their serostatus [11, 12]. For populations with HIV risktaking behaviors, regular testing is critical, given that most individuals reduce HIV transmission risk behaviors following an HIV diagnosis, that early ART treatment reduces risk of transmission to sexual and drug using partners by lowering viral load, and at an individual level lowers risk for AIDS-defining illnesses and death [14]. In addition to oppressive gender norms ascribed to Black men surrounding HIV transmission risk, individual barriers to testing include low perceived risk, endorsing HIV conspiracy beliefs, and perceived low access to testing [26, 27]. We examine gaps in HIV testing initiatives and describe potential novel approaches to lessen barriers and intersectional stigma and develop sustainable HIV testing, treatment, and care programs for this marginalized priority population
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