HIV Testing Among Internet-Using MSM in the United States: Systematic Review

Abstract

Regular HIV testing enables early identification and treatment of HIV among at-risk men who have sex with men (MSM). Characterizing HIV testing needs for Internet-using MSM informs development of Internet-facilitated testing interventions. In this systematic review we analyze HIV testing patterns among Internet-using MSM in the United States who report, through participation in an online study or survey, their HIV status as negative or unknown and identify demographic or behavioral risk factors associated with testing. We systematically searched multiple electronic databases for relevant English-language articles published between January 1, 2005 and December 16, 2014. Using meta-analysis, we summarized the proportion of Internet-using MSM who had ever tested for HIV and the proportion who tested in the 12 months preceding participation in the online study or survey. We also identified factors predictive of these outcomes using meta-regression and narrative synthesis. Thirty-two studies that enrolled 83,186 MSM met our inclusion criteria. Among the studies reporting data for each outcome, 85 % (95 % CI 82–87 %) of participants had ever tested, and 58 % (95 % CI 53–63 %) had tested in the year preceding enrollment in the study, among those for whom those data were reported. Age over 30 years, at least a college education, use of drugs, and self-identification as being homosexual or gay were associated with ever having tested for HIV. A large majority of Internet-using MSM indicated they had been tested for HIV at some point in the past. A smaller proportion—but still a majority—reported they had been tested within the year preceding study or survey participation. MSM who self-identify as heterosexual or bisexual, are younger, or who use drugs (including non-injection drugs) may be less likely to have ever tested for HIV. The overall findings of our systematic review are encouraging; however, a subpopulation of MSM may benefit from targeted outreach. These findings indicate unmet needs for HIV testing among Internet-using MSM and identify subpopulations that might benefit from targeted outreach, such as provision of HIV self-testing kits.

Prevalence and Factors Associated With HIV Self-testing Uptake Among Men Who Have Sex With Men in Ningbo, China: A Cross-sectional Study

“…This study demonstrated that HIVST users were more like to have a higher frequency of HIV testing and regular HIV testing compared to non-HIVST users. Regular HIV testing enables early identi cation and treatment of HIV among at-risk MSM 30 . As mentioned, the US CDC recommends MSM to take up HIV testing every 3 to 6 months if they have additional HIV risk factors 31 .…”

Trends in Internet Use Among Men Who Have Sex With Men in the United States

“…A recent meta-analyses of HIV testing among MSM recruited online suggests that HIV-testing frequency is suboptimal and there is room for improvement. 26 The ability to target messages to specific populations, on specific apps or websites, or in specific geographic areas gives great power to public health practitioners to tailor messages for maximum impact.…”

HIV Prevention Research on Men Who Have Sex With Men: A Scoping Review of Systematic Reviews, 1988–2017

“…Eight reviews (6%; mean quality, moderate) focused on testing for HIV, STIs, and other diseases (e.g., anal cancer). One was a meta-analysis (Noble, Jones, Bowles, DiNenno, & Tregear, 2017). Seven reviews did not focus on a specific MSM subpopulation.…”

“…Of the four reviews that included descriptive data, two suggested that fear of a positive test result was a major reason for not testing (Flowers & Church, 2002;, one reported that few HIV guidelines recommended digitalrectal exams for anal cancer screening (Ong, Chen, Grulich, & Fairley, 2014), and one suggested that annual screening for pharyngeal gonorrhea can miss this diagnosis given its short duration of infection compared to chlamydia and rectal gonorrhea (Chow et al, 2016). Of the two prevalence-related reviews, one suggested that persistent high rates of STI among MSM may be due to a disconnect between screening recommendations for STI and actual screening (Lutz, 2015); the other found that 85% of Internet-using MSM had tested for HIV (Noble et al, 2017). The latter review also provided correlational data and found that age >30 years, college education, drug use, and self-identification as gay were associated with HIV testing.…”