Testing the Testers: Are Young Men Who Have Sex With Men Receiving Adequate HIV Testing and Counseling Services?

Abstract

Background The United States Centers for Disease Control and Prevention (CDC) promote HIV testing every six months among young men who have sex with men (YMSM) to facilitate entry into the HIV prevention and care continuum. Willingness to be tested may be influenced by testing services’ quality. Using a novel mystery shopper methodology, we assessed YMSM’s testing experiences in three cities and recommend service delivery improvements. Methods We assessed YMSM’s experiences at HIV testing sites in Philadelphia (n=30), Atlanta (n=17), and Houston (n=19). YMSM (18–24) were trained as mystery shoppers and each site was visited twice. After each visit, shoppers completed a quality assurance (QA) survey to evaluate their experience. Data were pooled across sites, normed as percentages, and compared across cities. Results Across cites, visits averaged 30 minutes (sd=25.5) and were perceived as welcoming and friendly (70.9%). YMSM perceived most sites respected their privacy and confidentiality (84.3%). YMSM noted deficiencies in providers’ competencies with sexual minorities (63.4%) and comfort during the visit (65.7%). Sites underperformed on LGBT visibility (49.6%) and medical forms inclusivity (57.95%). Sites on average did not discuss YMSM’s relationship context (49.8%) nor provide risk reduction counseling (56.8%) or safer sex education (24.3%). Sites delivered PrEP information and counseling inconsistently (58.8%). Conclusions Testing sites’ variable performance underscores the importance of improving HIV testing services for YMSM. Strategies are recommended for testing sites to promote cultural sensitivity: funding staff trainings, creating systems to assess adherence to testing guidelines and best practices, and implementing new service delivery models.

Strengthening HIV Prevention Services Through an Implementation Science Approach: Perspectives From the HIV Testers in Philadelphia

“…Conceptual implementation research logic model. Our implementation logic model aligns with the ISC 3 I logic model recommended for EHE grantees. Within this model, our CFAR EHE planning supplement has highlighted how key factors across CFIR domains hinder the effective implementation of PrEP for YMSM/TW in Philadelphia.…”

“…2 Although increasing individual-level PrEP awareness is essential, PrEP can only lead to population-level HIV reductions if health systems have the knowledge, capacity, and infrastructure for successful and inclusive HIV testing and PrEP implementation. 3 However, HIV testing expansion and PrEP implementation efforts across the United States have been inequitably distributed. 4,5 Consistent with national trends, 6,7 HIV testing and PrEP initiation rates among non-Latinx Black and Latinx individuals have been lower than their White counterparts.…”

Enhancing routine HIV and STI testing among young men who have sex with men: primary outcomes of the get connected clinical randomized trial (ATN 139)

“…This study was registered on ClinicalTrials.gov (NCT03132415) on April 24, 2017. Details on the full protocol can be found elsewhere [ 34 , 40 ].…”

“…Tailoring at the site level was informed by a mystery shopping method [ 40 ]. The intervention ranked providers in the “Your Sites” page based on baseline mystery shopper data.…”

Constructing a web‐based health directory for adolescent men who have sex with men: Strategies for development and resource verification

“…The ability to successfully buffer or compensate against these vulnerabilities requires youth to activate intrinsic assets (e.g., resilience, self‐esteem) and to have access to health‐promoting resources in their social and physical environments (Fergus & Zimmerman, 2005; Ungar et al, 2013). Although providing referrals and access to supportive agencies is a long‐standing strategy to reinforce social support, education, and learning in the adolescent health literature (Ambresin et al, 2013; Harper et al, 2012; Mazur et al, 2018), access to health services that are welcoming and affirming of sexual minorities varies widely across the United States (US) (Bauermeister et al, 2019; Sirdenis et al, 2019).…”