MSM Testing Research Articles

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials.

An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.

Identifying Barriers to Human Immunodeficiency Virus Testing for Men Who Have Sex with Men in South Korea

ObjectivesThe principal objective of this study was to identify the barriers to testing for men who have sex with men (MSM) in Korea, something that might prove useful in future studies of this nature. MethodsThis study was conducted at gay bars nationwide in Korea. After considering several offline locations (gay bars) where MSM candidates are commonly located, random recruitment was performed using time–location sampling. A total of 944 individuals participated in this survey. A total sample of 921 cases (23 cases were excluded) was used for analysis. A self-administered questionnaire measuring the individuals' demographics, human immunodeficiency virus (HIV)/AIDS knowledge, stigma, phobia, optimism bias, self-efficacy for condom use, and sexual practices was used. ResultsAbout 61.8% (N = 569) of respondents reported having been tested at least once in their lifetime, and 38.9% (N = 358) acknowledged being tested within the past 12 months. After adjusting for age, education, and number of partners in a logistic regression analysis, awareness of testing place [odds ratio (OR) = 4.04], exposure to HIV prevention campaign (1.54), fear (OR = 1.13), and discrimination toward people with HIV/AIDS (OR = 0.94) were the main factors associated with HIV testing. ConclusionTo accomplish widespread HIV testing for Korean MSM, the accessibility of testing centers and advertisement of voluntary counseling and testing to MSM are needed.

Correlates of internalized homonegativity among black men who have sex with men.

Black men who have sex with men (MSM) carry a disproportionate burden of HIV in the United States. Such disparities cannot be attributed to individual behavioral risk factors alone, prompting the exploration of social and contextual factors experienced by minority MSM. Societal homonegativity and the internalization of those attitudes by Black MSM may play an important role in understanding racial and ethnic disparities in HIV incidence and prevalence. This study explores the correlates of internalized homonegativity in a large multi-site sample of Black MSM. Findings reveal a number of significant contextual and psychosocial factors related to internalized homonegativity including religiosity, resilience, and gay community acculturation, which have important implications for HIV risk, HIV testing, and social and psychological wellbeing for Black MSM.

Duration of syphilis symptoms at presentations in men who have sex with men in Australia: are current public health campaigns effective?

The rapid rise in syphilis cases has prompted a number of public health campaigns to assist men who have sex with men (MSM) recognize and present early with symptoms. This study aimed to investigate the temporal trend of the duration of self-report symptoms and titre of rapid plasma reagin (RPR) in MSM with infectious syphilis. Seven hundred and sixty-one syphilis cases in MSM diagnosed at the Melbourne Sexual Health Centre (MSHC) from 2007-2013 were reviewed. Median duration of symptoms and RPR titres in each year were calculated. The median durations of symptoms with primary and secondary syphilis were 9 [interquartile range (IQR) 6-14] days and 14 (IQR 7-30) days, respectively. The overall median titre of RPR in secondary syphilis (median 128, IQR 64-256) was higher than in primary syphilis (median 4, IQR 1-32) and in early latent syphilis (median 32, IQR 4-64). The median duration of symptoms for primary syphilis, secondary syphilis and titre of RPR level did not change over time. Public health campaigns were not associated with a significant shorter time from onset of symptoms to treatment. Alternative strategies such as more frequent testing of MSM should be promoted to control the syphilis epidemic in Australia.

P238 Hepatitis C testing in msm – are we asking the right questions?

Background Concern regarding high rates of hepatitis C infection in sub-groups of MSM may warrant targeted testing. Aim We examine whether we routinely collect the necessary information from MSM to identify those at risk and target hepatitis C testing, and assess whether our concerns about emerging risk factors for hepatitis C are implicated in new diagnoses in our cohort. Methods Notes audit of all MSM GUM attendances during November 2013 assessed documentation of fisting, rectal bleeding with sex, group sex, and drug use, as well as hepatitis testing. Notes of all patients coded for hepatitis C infection during 2011–2013 were examined to assess risk factors for hepatitis C infection. Results 147 MSM attendances were reviewed. The proportion of men asked about specific risk factors was: drug use (18%), rectal bleeding (1%), group sex (1%), fisting (1%). 8% MSM had hepatitis C screens, none with traditional risk factors. Over 3 years, 46 patients were coded for hepatitis C. 34% of these were new infections. 33% were HIV positive, 48% had injected drugs (41% no documentation), 22% had hepatitis C positive partners, 11% were sex workers. Discussion/conclusion Drug use and high risk sexual practices were not always fully recorded in our sample. Testing rates were low and did not seem to relate to identifiable risks. We identified few cases of new infection, largely limited to patients with traditional risk factors. It is not clear if better recording of risk factors would lead to increased Hepatitis C testing or diagnosis.

P221 Drug and alcohol misuse is associated with STIS in men who have sex with men (MSM)

Background/introduction Alcohol and recreational drug misuse is an increasing problem in sexual health clinics, particularly MSM where it is often associated with unsafe sexual practices and increasing prevalence of sexually transmitted infections (STIs). Aims/objectives To determine the proportion of MSM testing positive for STIs reporting substance misuse in a dedicated sexual health clinic, compared to the proportion attending THT services reporting high risk sexual activity requiring support for substance misuse. Methods Case notes of patients attending a MSM clinic testing positive for STIs over a 6 month period were reviewed. Data was collected on type of STI, recreational drug and alcohol use. Over the same period, data on high-risk sexual activity and referral to specialist drug and alcohol services was collected for MSM attending THT services. Results 285 MSM attended the sexual health clinic, whereby 97 (34%) tested positive for 1 or more STI. 88 cases of gonorrhoea were seen, 49 cases of chlamydia, 20 cases of syphilis and 7 new HIV infections. Of those testing positive for STIs, 45 (46%) reported alcohol and/or recreational drug misuse. Of the 162 MSM attending THT services, 90 (56%) reported high risk sexual behaviour with concurrent substance misuse. 27 (30%) were referred to specialist substance misuse services. Discussion/conclusions High rates of substance misuse associated with high risk sexual activity were seen in the MSM clinic and at THT. This reinforces the importance of screening and brief intervention/referral for substance misuse as a risk reduction strategy for STIs and HIV.

What is the role of sexually transmitted disease clinics?

What is the role of sexually transmitted disease clinics?

HIV and syphilis testing preferences among men who have sex with men in South China: a qualitative analysis to inform sexual health services.

BackgroundHealth services for men who have sex with men (MSM) are inadequate in many areas around the world. HIV and syphilis test uptake remain suboptimal among MSM in China and many other regions. To inform the development of more comprehensive sexually transmitted disease (STD) testing programs among MSM, we collected descriptive data on MSM testing practices and preferences.MethodsMSM in two large urban Chinese cities were recruited through community-based organizations and clinics to participate in semi-structured interviews. We purposively sampled MSM across a range of sociodemographic characteristics and testing history, and assessed preferences for HIV and syphilis testing in the context of facilitators and barriers to testing and previous testing experiences. Each interview transcript was coded and thematically analyzed using Atlas.ti 7.0.Results35 MSM were interviewed. Confidentiality and privacy were the most important factors influencing participants’ decisions about whether and where to get tested. Men preferred rapid testing (results available within 30 minutes) compared to conventional tests where results take several hours or days to return. Participants described concerns about quality and accuracy of rapid tests offered in non-clinical settings such as community-based organizations. Men preferred testing service providers who were MSM-friendly, non-discriminatory, and medically trained. Preferred service center environments included: convenient but discrete location, MSM-friendly atmosphere, and clean/standard medical facilities.ConclusionOur data highlight the need for HIV/syphilis testing services that are confidential and inclusive of MSM. Rapid testing in decentralized (i.e. peripheral health facilities and community-level, non-clinical venues) settings provides an opportunity to reach individuals who have not been tested before, but must be accompanied by quality assurance systems and technical competence. Implementation research could further evaluate HIV/syphilis testing programs responsive to MSM preferences.Short SummaryA qualitative study of MSM in South China found that men preferred rapid STD testing at MSM-focused test centers, but were concerned about test quality assurance and confidentiality.

Home sampling for sexually transmitted infections and HIV in men who have sex with men: a prospective observational study.

To determine uptake of home sampling kit (HSK) for STI/HIV compared to clinic-based testing, whether the availability of HSK would increase STI testing rates amongst HIV infected MSM, and those attending a community-based HIV testing clinic compared to historical control. Prospective observational study in three facilities providing STI/HIV testing services in Brighton, UK was conducted. Adult MSM attending/contacting a GUM clinic requesting an STI screen (group 1), HIV infected MSM attending routine outpatient clinic (group 2), and MSM attending a community-based rapid HIV testing service (group 3) were eligible. Participants were required to have no symptomatology consistent with STI and known to be immune to hepatitis A and B (group 1). Eligible men were offered a HSK to obtain self-collected specimens as an alternative to routine testing. HSK uptake compared to conventional clinic-based STI/HIV testing in group 1, increase in STI testing rates due to availability of HSK compared to historical controls in group 2 and 3, and HSK return rates in all settings were calculated. Among the 128 eligible men in group 1, HSK acceptance was higher (62.5% (95% CI: 53.5–70.9)) compared to GUM clinic-based testing (37.5% (95% CI: 29.1–46.5)), (p = 0.0004). Two thirds of eligible MSM offered an HSK in all three groups accepted it, but HSK return rates varied (highest in group 1, 77.5%, lowest in group 3, 16%). HSK for HIV testing was acceptable to 81% of men in group 1. Compared to historical controls, availability of HSK increased the proportion of MSM testing for STIs in group 2 but not in group 3. HSK for STI/HIV offers an alternative to conventional clinic-based testing for MSM seeking STI screening. It significantly increases STI testing uptake in HIV infected MSM. HSK could be considered as an adjunct to clinic-based services to further improve STI/HIV testing in MSM.

HIV in Thai men who have sex with men: a sustained emergency

In The Lancet HIV, Frits van Griensven and colleagues1 report high HIV incidence in men who have sex with men (MSM) in Bangkok, Thailand, in two different cohort settings: an MSM-friendly clinic, at which testing and counselling services and other sexual health services were provided on request and a closed prospective cohort of MSM testing at routine intervals. The HIV incidence of 5·5 per 100 person years in both groups is alarmingly high, but unsurprising because high and sustained transmission is being noted across the region in young homosexual, bisexual, and other MSM.

Sexual Behavior and HIV Testing Practices among Men who have Sex with Men in Portugal

The objective of the study was to explore sexual behavior and HIV-testing practices among men who have sex with men (MSM) in Portugal, in light of current international health guidelines that recommend frequent HIV testing for MSM who engage in high-risk behavior. Participants were 304 mostly young, gay or bisexual self-identified MSM. They provided information regarding their HIV status (67% negative, 7% positive, 26% didn’t know), 24% had never been tested for HIV, and 15.5% had been tested only once; main reasons for never having tested previously were: always using condoms, and not feeling at risk. Thus, HIV testing was infrequent and insufficient for early detection of infection, entry into treatment, and protection of sexual partners, since many unprotected sexual practices still occur. Those who tested more were older, self-identified as gay, living in major urban areas and employed. Linear regression predicted that the number of times MSM had penetrative sex without a condom was associated with the number of times they got tested, indicating that they might be using the test itself as a means to gain control of their unprotected sexual practices. Testing campaigns should aim to help MSM become more aware of their risk behavior, decrease fear of testing by explaining available treatment resources and decreasing the stigma associated with HIV, and by publicizing information about free and confidential testing locations.

Taming the great: enhanced syphilis screening in HIV-positive men who have sex with men in a hospital clinic setting.

Syphilis incidence in HIV-positive men who have sex with men (MSM) continues to increase, with strategies based on early detection and treatment urgently required to control rising infections. There are barriers to enhanced testing in certain settings. At our tertiary referral HIV centre, testing rates before and after a period of enhanced syphilis testing in HIV-positive MSM were assessed. When compared with the control period (pre-enhanced screening), the enhanced syphilis testing was associated with a significant increase in syphilis testing of HIV-positive patients undergoing routine viral load testing (136 out of 574, 23% vs 317 out of 574, 55%; P<0.0001) and a three-fold increase in new syphilis diagnoses (4 out of 574 vs 18 out of 574, P=0.004).

Repeated STI and HIV testing among HIV-negative men who have sex with men attending a large STI clinic in Amsterdam: a longitudinal study.

In the Netherlands, men who have sex with men (MSM) are advised via informal guidelines to test for STI at least annually. We estimated the proportion of HIV-negative MSM testing repeatedly at 12-month or smaller intervals at a large STI clinic in the Netherlands. In addition, we explored whether repeated testing is related to risk behaviour. Longitudinal data of HIV-negative MSM visiting the Amsterdam STI clinic between 2009 and 2012 were analysed. To estimate the timing of repeated testing, Kaplan-Meier methods were used. Determinants for repeated testing (distinguishing testing at 12-month or smaller intervals and less than 12-monthly testing, with single testers as reference group) were identified using multivariate multinomial logistic regression analyses. In total, 19,479 consultations of 9174 HIV-negative MSM were identified. Of these MSM, 35% (95% CI 33% to 36%) were estimated to return to the STI clinic within 1 year following baseline consultation. Among 1767 men with at least two consultations and at least 2 years between baseline and last consultation, 43% tested repeatedly at 12-month or smaller intervals in those first 2 years. Repeated testers reported higher sexual risk behaviour (ie, only casual or both casual and steady sex partners, higher numbers of sex partners) at baseline compared with single testers. This effect tended to be slightly stronger for men testing repeatedly at 12-month or smaller intervals. The proportion of MSM testing for STI annually is low. MSM testing repeatedly had higher baseline levels of risk behaviour. Strategies to motivate MSM to test annually should be explored.

Experiences and correlates of HIV self-testing among men who have sex with men in Jiangsu province, China.

Substantial numbers of Chinese men who have sex with men (MSM) do not access facility-based HIV testing. Self-testing could promote testing uptake among this population. We describe experiences and identify correlates of self-testing among Chinese MSM. A cross-sectional survey was conducted among MSM in Jiangsu from November 2013 to January 2014. Participants were recruited through time-location sampling and from online. Participants were asked a series of questions about HIV self-testing uptake and associated experiences. Logistic regression was used to identify correlates of having ever self-tested for HIV. Of 522 participants, 26.2 % had ever self-tested. Finger stick was the most common self-testing modality (86.1 %). A majority of participants reported that it was "very easy" (43.1 %) or "somewhat easy" (34.3 %) to perform self-testing while lower proportions reported "very confident" (24.1 %) or "somewhat confident" (36.5 %) in the accuracy of their test results. Having ever self-tested was significantly associated with having had 2-5 and 6 or more male anal sex partners in the past 6 months (AOR 2.12, 95 % CI 1.00, 4.49; AOR 4.95, 95 % CI 1.90, 12.87), having ever tested for HIV (AOR 4.56, 95 % CI 1.66, 12.55), and having a friend or friends who self-tested (AOR 7.32, 95 % CI 3.57, 15.00). HIV self-testing can reach untested Chinese MSM and/or increase testing frequency. Peer- or social network-based interventions could futher help encourage self-testing. Monitoring systems should be strengthened to ensure the quality of self-testing kits and provision of essential support services, including post-test counseling and linkage-to-care.

Organizational characteristics of HIV/syphilis testing services for men who have sex with men in South China: a social entrepreneurship analysis and implications for creating sustainable service models.

BackgroundUNAIDS has called for greater HIV/syphilis testing worldwide just as local HIV/syphilis testing programs are cut or altered. New models are needed to make HIV/syphilis testing services sustainable while retaining their essential public health function. Social entrepreneurship, using business principles to promote a social cause, provides a framework to pilot programs that sustainably expand testing. Drawing on fieldwork in two South Chinese cities, we examined organizational and financial characteristics of current HIV/syphilis testing systems for men who have sex with men (MSM) in addition to new pilot programs focused on revenue-generation for sustainability.MethodsWe undertook a qualitative study to explore organizational and financial characteristics of HIV/syphilis testing for MSM. Data were collected from men who have sex with men and policy stakeholders in Guangzhou and Hong Kong. Framework analysis was used to identify themes and then code the data.ResultsOur qualitative research study included MSM and policy stakeholders (n = 84). HIV/syphilis testing services were implemented at a wide range of organizations which we grouped broadly as independent community-based organizations (CBOs), independent clinics, and hybrid CBO-clinic sites. From an organizational perspective, hybrid CBO-clinic sites offered the inclusive environment of an MSM CBO linked to the technical capacity and trained staff of a clinic. From a financial perspective, stakeholders expressed concern about the sustainability and effectiveness of sexual health services reliant on external funding. We identified four hybrid CBO-clinic organizations that launched pilot testing programs in order to generate revenue while expanding HIV testing.ConclusionMany MSM CBOs are searching for new organizational models to account for decreased external support. Hybrid CBO-clinic organizations create a strong foundation to increase HIV/syphilis testing using social entrepreneurship models in China.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0601-5) contains supplementary material, which is available to authorized users.

The Mpumalanga Men's Study (MPMS): results of a baseline biological and behavioral HIV surveillance survey in two MSM communities in South Africa.

The Mpumalanga Men's Study (MPMS) is the assessment of the Project Boithato HIV prevention intervention for South African MSM. Boithato aims to increase consistent condom use, regular testing for HIV-negative MSM, and linkage to care for HIV-positive MSM. The MPMS baseline examined HIV prevalence and associated risk behaviors, and testing, care, and treatment behaviors among MSM in Gert Sibande and Ehlanzeni districts in Mpumalanga province, South Africa in order to effectively target intervention activities. We recruited 307 MSM in Gert Sibande and 298 in Ehlanzeni through respondent-driven sampling (RDS) between September 2012-March 2013. RDS-adjusted HIV prevalence estimates are 28.3% (95% CI 21.1%–35.3%) in Gert Sibande, and 13.7% (95% CI 9.1%–19.6%) in Ehlanzeni. Prevalence is significantly higher among MSM over age 25 [57.8% (95% CI 43.1%–72.9%) vs. 17.9% (95% CI 10.6%–23.9%), P<0.001 in Gert Sibande; 34.5% (95%CI 20.5%–56.0%) vs. 9.1% (95% CI 4.6%–13.9%), P<0.001 in Ehlanzeni]. In Gert Sibande, prevalence is higher among self-identified gay and transgender MSM vs. other MSM [39.3% (95%CI, 28.3%–47.9%), P<0.01], inconsistent condom users [38.1% (18.1%–64.2%), P<0.05], those with a current regular male partner [35.0% (27.1%–46.4%), P<0.05], and those with lifetime experience of intimate partner violence with men [40.4%, (95%CI 28.9%–50.9%), P<0.05]. Prevalence of previous HIV testing was 65.8% (95%CI 58.8%–74.0%) in Gert Sibande, and 69.3% (95%CI 61.9%–76.8%) in Ehlanzeni. Regular HIV testing was uncommon [(34.6%, (95%CI 27.9%–41.4%) in Gert Sibande; 31.0% (95%CI 24.9%–37.8%) in Ehlanzeni]. Among HIV-positive participants, few knew their status (28.1% in Gert Sibande and 14.5% in Ehlanzeni), or were appropriately linked to care (18.2% and 11.3%, respectively), or taking antiretroviral therapy (13.6% and 9.6% respectively). MPMS results demonstrate the importance of implementing interventions for MSM to increase consistent condom use, regular HIV testing, and linkage and engagement in care for HIV-infected MSM.

Promoting Regular Testing: An Examination of HIV and STI Testing Routines and Associated Socio-Demographic, Behavioral and Social-Cognitive Factors Among Men Who have Sex with Men in New South Wales, Australia

Human immunodeficiency virus (HIV) and sexually transmitted infections (STI) testing rates are amongst the highest in the world among men who have sex with men (MSM) in Australia. However, notable minorities have never tested and many MSM have not tested recently. To examine testing routines and assess covariates of testing, an online survey was conducted among MSM in New South Wales. Five hundred and eighty non-HIV positive MSM (Mean age: 29.33 years) were randomized to answer questions on barriers to testing for HIV or STI. One in five (20.9 %) non-HIV-positive participants had never tested for HIV, 27.2 % had no HIV testing routines, 22.8 % had a moderate HIV testing routines, and 29.1 % had strong HIV testing routines. Similar patterning was observed for STI testing. In multivariate analyses participants' knowledge, beliefs, attitudes, subjective norms and perceived behavioral control were moderately related to HIV and/or STI testing routines and some associations were specific to either HIV or STI testing or to particular routines. Findings highlight that multiple social-cognitive factors each play a role in explaining HIV and STI testing among MSM. To effectively promote regular testing in MSM, programs face the challenge of having to address a range of hurdles, rather than a few major obstacles.

Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence

Men who have sex with men (MSM) in Australia and overseas are disproportionately affected by sexually transmissible infections (STIs), including HIV. Many STIs are asymptomatic, so regular testing and management of asymptomatic MSM remains an important component of effective control. We reviewed articles from January 2009-May 2013 to inform the 2014 update of the 2010 Australian testing guidelines for asymptomatic MSM. Key changes include: a recommendation for pharyngeal chlamydia (Chlamydia trachomatis) testing, use of nucleic acid amplification tests alone for gonorrhoea (Neisseria gonorrhoeae) testing (without gonococcal culture), more frequent (up to four times a year) gonorrhoea and chlamydia testing in sexually active HIV-positive MSM, time required since last void for chlamydia first-void urine collection specified at 20min, urethral meatal swab as an alternative to first-void urine for urethral chlamydia testing, and the use of electronic reminders to increase STI and HIV retesting rates among MSM.

Sexually transmitted infection testing practices among ‘money boys’ and general men who have sex with men in Shanghai, China: objective versus self-reported status

Little is known about sexually transmitted infection (STI) testing among Chinese men who have sex with men (MSM). This study describes the prevalence of STI testing, associated factors and the validity of STI self-reporting among Chinese MSM. Findings indicated a high prevalence of STIs and low testing rates among MSM in Shanghai. Monthly income was significantly associated with STI testing (odds ratio: 0.37, 95% confidence interval (CI): 0.18 to 0.76). Depression was significantly associated with STI testing for general MSM (odds ratio: 1.09, 95% CI: 1.01 to 1.17). Syphilis self-reported status had the highest validity (k=0.33, χ(2)=3.76, 95% CI: -0.003 to 0.65). Efforts are needed to ensure that STI testing services are accessible to MSM in China. Future HIV and STI interventions should be tailored to the needs of different subsets of MSM.

Factors associated with regular HIV testing among a sample of US MSM with HIV-negative main partners.

: HIV transmission is common within men who have sex with men (MSM) couples; despite recommendations that MSM who engage in risky sexual behaviors get tested biannually/annually, little is known about the testing patterns of MSM while in a current primary relationship. This study compared demographic and relationship characteristics of groups of MSM with different testing patterns while in their primary relationships and assessed which factors were associated with regular or irregular testing. Two hundred seventy-five HIV-negative male couples/550 MSM were recruited online to complete a survey in 2011. Since the start of their relationship, 21% of MSM tested for HIV every 3, 4, or 6 months; 29% tested once a year; 30% tested only when they felt at risk for HIV; and 20% never tested for HIV. Bivariate analyses indicated that men who had never been tested while in their relationship were younger, less educated, had greater trust in their partner, and were less likely to be in a couple that had 1 or both men having had sex with someone else. In the multivariate analyses, testing at regular intervals was associated with higher education, having a sexual agreement, being in a couple that had 1 or both men having had sex with someone else, and having lower faith in trust toward the main partner. Findings suggest that many MSM's testing behaviors while in their primary relationship do not align with their risk profile. Trust seems to be a barrier to regular HIV testing, which may be addressed by encouraging MSM to negotiate clear sexual agreements with their primary partner.