HIV Testing Patterns among Black Men Who Have Sex with Men: A Qualitative Typology

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.

Contributions of Qualitative Research in Informing HIV/AIDS Interventions Targeting Black MSM in the United States

“…Other dimensions of diversity pertinent to consider in the development of interventions targeted toward BMSM include HIV testing patterns and HIV status disclosure (Bird amp; Voisin, 2013; Harawa, Williams, Ramamurthi, amp; Bingham, 2006; Hussen et al, 2013; Lichtenstein, 2000; Miller, 2007; Wheeler, 2005; Williams et al, 2004), age (Eyre, Milbrath amp; Peacock, 2007; Haile, Padilla amp; Parker, 2011; VenDevanter et al, 2011), and drug use (Jerome amp; Halkitis, 2009; Washington amp; Brocato, 2011; Washington amp; Meyer-Adams, 2010; Wilton et al, 2005; Wu, El-Bassel, McVinney, Fontaine, amp; Hess, 2010). Several studies explicitly noted that interventions need to be cognizant that there is no one “type” of BMSM and therefore narrowly-focused interventions will be limited in their impacts (Arnold amp; Bailey, 2009; Fields et al, 2015; Hightow-Weidman et al, 2011; Hussen et al, 2013; Washington amp; Brocato, 2011).…”

“…Several studies explicitly noted that interventions need to be cognizant that there is no one “type” of BMSM and therefore narrowly-focused interventions will be limited in their impacts (Arnold amp; Bailey, 2009; Fields et al, 2015; Hightow-Weidman et al, 2011; Hussen et al, 2013; Washington amp; Brocato, 2011). …”

Understanding Structural Barriers to Accessing HIV Testing and Prevention Services Among Black Men Who Have Sex with Men (BMSM) in the United States

“…Only 67 % of HIV-negative BMSM in one study were tested for HIV in the last 2 years [27] and only 52 % in another study were tested in the last year [28]. Other findings highlight the heterogeneity of HIV testing patterns among BMSM [29]. HIV-infected BMSM are also less likely than other HIV-infected MSM to be aware of their positive serostatus [10, 30–32].…”

A Comparison of Referred Sexual Partners to Their Community Recruited Counterparts in The BROTHERS Project (HPTN 061)

“…Recent studies have found high HIV infection rates, particularly among young African American MSM [5, 6]. HIV prevention research has shown that high rates of HIV among African American MSM may in part be attributed to younger sexual debut [7], older sexual partners [8], sexually transmitted infection (STI) rates, sexual mixing within African American networks that facilitate HIV transmission [8–11], infrequent HIV testing [12], and undetected or late diagnosis of HIV infection [13, 14]. These issues are compounded by African American MSM poor access to quality medical care and HIV antiretroviral therapies [15, 16].…”