Health System and Personal Barriers Resulting in Decreased Utilization of HIV and STD Testing Services among At-Risk Black Men Who Have Sex with Men in Massachusetts

Abstract

Testing for HIV and other sexually transmitted diseases (STD) remains a cornerstone of public health prevention interventions. This analysis was designed to explore the frequency of testing, as well as health system and personal barriers to testing, among a community-recruited sample of Black men who have sex with men (MSM) at risk for HIV and STDs. Black MSM (n = 197) recruited via modified respondent-driven sampling between January and July 2008 completed an interviewer-administered assessment, with optional voluntary HIV counseling and testing. Logistic regression procedures examined factors associated with not having tested in the 2 years prior to study enrollment for: (1) HIV (among HIV-uninfected participants, n = 145) and (2) STDs (among the entire mixed serostatus sample, n = 197). The odds ratios and their 95% confidence intervals obtained from this analysis were converted to relative risks. (1) HIV: Overall, 33% of HIV-uninfected Black MSM had not been tested for HIV in the 2 years prior to study enrollment. Factors uniquely associated with not having a recent HIV test included: being less educated; engaging in serodiscordant unprotected sex; and never having been HIV tested at a community health clinic, STD clinic, or jail. (2) STDs: Sixty percent had not been tested for STDs in the 2 years prior to study enrollment, and 24% of the sample had never been tested for STDs. Factors uniquely associated with not having a recent STD test included: older age; having had a prior STD; and never having been tested at an emergency department or urgent care clinic. Overlapping factors associated with both not having had a recent HIV or STD test included: substance use during sex; feeling that using a condom during sex is "very difficult"; less frequent contact with other MSM; not visiting a health care provider (HCP) in the past 12 months; having a HCP not recommend HIV or STD testing at their last visit; not having a primary care provider (PCP); current PCP never recommending they get tested for HIV or STDs. In multivariable models adjusting for relevant demographic and behavioral factors, Black MSM who reported that a HCP recommended getting an HIV test (adjusted relative risk [ARR] = 0.26; p = 0.01) or STD test (ARR = 0.11; p = 0.0004) at their last visit in the past 12 months were significantly less likely to have not been tested for HIV or STDs in the past 2 years. Many sexually active Black MSM do not regularly test for HIV or STDs. HCPs play a pivotal role in encouraging testing for Black MSM. Additional provider training is warranted to educate HCPs about the specific health care needs of Black MSM, in order to facilitate access to timely, culturally competent HIV and STD testing and treatment services for this population.

Vulnerability in the context of HIV and syphilis infection in a population of men who have sex with men (MSM) in Salvador, Bahia State, Brazil

“…Some RDS studies have found fewer sexual partners than in this study 24,28,39,40 , but our findings are close to other results of RDS studies with MSM 6,25,27,30 . Still, such differences may be due to the lack of a standardized period for which the number of partners was computed, varying widely in the literature, or to characteristics like the size of MSM social networks, age, schooling, and social class, factors that may be associated with the number of sexual partners in this sample.…”

“…Reporting a previous syphilis test was statistically associated with HIV infection and syphilis, as in other studies 24,28 , but it can also be associated with risky sexual practices for STI 24,27,28,41 .…”

“…The percentage of participants that reported a previous HIV test (37%) was close to that of Brazil's general population (36.5%) 33 and higher than the country's male population (27%) 33 , but some 50% lower than in a population of black and Latino MSM in the United States 24,41 , or among MSM with high-risk practices for HIV infection 28 . It was also lower than the results presented in the last report of the Joint United Nations Programme on HIV/AIDS (UNAIDS) (42%) 12 and in the Brazilian multicenter study (49%) 3 and other populations of MSM 42 .…”

“…The literature agrees on the need to expand testing for HIV and other STI since it can reduce involvement in risky sexual practices for STI 12,24,25,28,29,31,41 .…”

“…Meanwhile, these estimates are high compared to the prevalence rates in the overall male population in Brazil (HIV: 0.8%; syphilis: 1.3%) 4,20 , male industrial workers (HIV: 1.7%; syphilis: 1.9%) 21 , military conscripts (HIV: 0.1%; syphilis: 0.5%) 22 , and in the Bela Vista Project with MSM (HIV: 2.1%; syphilis: 13.5%) 23 . Recent studies that also used the RDS methodology among MSM in different countries showed HIV infection prevalence rates greater than 10% 6,24,25,26 , and some studies have shown prevalence rates greater than 30% 27,28,29 .…”