HIV Testing Low Among Gay/Bisexual Male Teenagers

Veronica Hackethal, MD

September 03, 2015

Even though gay and bisexual male adolescents are among the highest-risk groups for contracting HIV, only 20% have been tested for the virus, according to a study by Northwestern University and the Center for Innovative Public Health Research.

The study was published online August 26 in the Journal of Adolescent Health.

Results also showed that the most important barriers to HIV testing included not knowing where to get tested, fear about being tested, and to a lesser degree, feeling invincible about not contracting HIV.

"Understanding the barriers to testing provides critical information for intervening, so we can help young men get tested," first author Gregory Phillips II, PhD, from the Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, said in a university news release.

The Centers for Disease Control and Prevention recommend that men who have sex with men (MSM) be tested for HIV at least once a year. The National HIV Behavioral Surveillance System, however, has reported that MSM aged 18 to 19 years have the lowest lifetime testing rate for HIV (75%), and only 64% have been tested in the last year. Rates for younger MSM may be even lower, according to background information in the article.

"Rates of new HIV infections continue to increase among young gay and bisexual men," senior author Brian Mustanski, PhD, who is also from the Department of Medical Social Sciences, Feinberg School of Medicine, said in the news release. "Testing is critical because it can help those who are positive receive lifesaving medical care. Effective treatment can also help prevent them from transmitting the virus to others," he emphasized.

Between June and November 2014, researchers used Facebook ads to recruit 302 adolescent gay, bisexual, and queer males between 14 and 18 years of age from across the United States. Recruitment occurred as part of a mobile health text-messaging-based HIV prevention program called Guy2Guy. Participants filled out online surveys about HIV testing behaviors, barriers to HIV testing, and consensual sexual experience.

Because the researchers used purposeful sampling for recruitment, results from this study may not represent population prevalence, the authors point out.

Results showed HIV testing rates that were much lower than those reported for adult MSM. Just 20.2% of participants had been tested for HIV, and only 30.3% of sexually active participants reported ever being tested.

Almost half of participants reported not knowing where to get tested for HIV (42.9%). Factors most frequently reported as important barriers for HIV testing included not knowing where to get tested (reported by 41.5% as "very important"), fear about testing or being recognized at the testing site (33.8%), and feeling invincible or not at risk for HIV (34.7%).

Further analyses suggested that not knowing where to get tested and fear about testing were significantly associated with not being tested, and that invincibility played a lesser role.

"Providing in-school testing would normalize the process," Dr Phillips said in the press release. "If there is a constant presence of on-site testing at schools, testing would seem less stigmatized. It would also increase knowledge about the testing process and make it less scary."

Only 33 states and the District of Columbia, however, mandate school-based HIV education, the authors point out. The Centers for Disease Control and Prevention offer school-based testing or school-based referral programs, as well as an online locator that could help youth find testing sites. Online and text-based messaging services such as Guy2Guy might also pick up the slack. In addition, the IMPACT program at Northwestern University has an online video explaining what it is like to get an HIV test and providing other health information for the LGBT community.

The study was supported by a grant from the National Institute of Mental Health of the National Institutes of Health. The authors have disclosed no relevant financial relationships.

J Adolesc Health. Published online August 26, 2015. Abstract


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