HIV Testing Among Men Who Have Sex with Men in the Northeastern United States

Men who have sex with men (MSM) continue to be at especially high risk for HIV in the United States. Past studies have shown that rates of HIV testing differ across a number of demographic and behavioral factors, and this research may be helpful for targeting efforts to increase testing among certain subgroups of MSM. In this study, MSM were recruited from several online sources to complete a questionnaire on HIV testing. Generalized ordered logit models suggested that the odds of having tested within the last 12 months were higher among racial/ethnic minority MSM, those with a college degree, and those who engaged in more recent HIV-risk behavior. The odds of having tested within the last 12 months were also higher among those who reported having sex with a partner they met online in the last 12 months. Conversely, the odds of having tested in the last 12 months were lower among those who reported drinking alcohol heavily, when compared with more moderate drinkers, highlighting yet another potential impact of alcohol on HIV outcomes.     

Recent HIV Testing Among Young Men Who Have Sex with Men in Bangkok and Chiang Mai: HIV Testing and Prevention Strategies Must Be Enhanced in Thailand

HIV infection among men who have sex with men, particularly in Thai urban settings and among younger cohorts, is escalating. HIV testing and counseling (HTC) are important for prevention and obtaining treatment and care. We examine data from a 2013 survey of males, 15–24 years, reporting past-year sex with a male and living in Bangkok or Chiang Mai. Almost three quarters of young MSM (YMSM) in Bangkok and only 27 % in Chiang Mai had an HIV test in the previous year. Associations for HIV testing varied between cities, although having employment increased the odds of HIV testing for both cities. In Bangkok, family knowledge of same sex attraction and talking to parents/guardians about HIV/AIDS had higher odds of HIV testing. Expanded HTC coverage is needed for YMSM in Chiang Mai. All health centers providing HTC, including those targeting MSM, need to address the specific needs of younger cohorts.     

Patterns of Lifetime and Recent HIV Testing Among Men Who Have Sex with Men in New York City Who Use Grindr

Rates of HIV infection continue to rise for men who have sex with men (MSM), and may be partially due to lack of testing among groups at risk for HIV. Mobile applications have demonstrated promise to identify at-risk MSM, though more research is needed to address testing patterns among this population. We conducted an online survey of 1,351 MSM in the New York City (NYC) area recruited from Grindr and analyzed predictors of lifetime and past-year testing using Pearson's chi-squared statistic, Fisher’s exact tests, and logistic regression. A majority (90 %) of men had been tested within their lifetimes, and most (71 %) had been tested within the prior year. Among those who had never been tested (n = 135), one-third had engaged in unprotected anal intercourse (UAI) in the prior 3 months and nearly one-third identified themselves as HIV-negative rather than unknown. Older age, reporting an HIV-negative (versus unknown) status, and recent UAI were independently associated with lifetime testing. Greater proportions of men who had recently engaged in UAI reported testing within the past year compared with those who had not engaged in UAI. Overall, rates of testing among MSM in this sample exceeded those of the general population, including the general population in NYC. A greater proportion of this sample had never tested compared to a population-based sample of NYC MSM, though a higher percentage had also tested in the past year. This study demonstrated that 1 in 10 NYC men using Grindr and 1 in 5 who were 18–24 years of age had never received an HIV test in their lives. Using the existing infrastructure and popularity of mobile technology such as Grindr to identify and link men to information regarding HIV testing may be a useful strategy for prevention.     

Acceptability of Smartphone Application-Based HIV Prevention Among Young Men Who Have Sex With Men

Young men who have sex with men (YMSM) are increasingly using mobile smartphone applications (“apps”), such as Grindr, to meet sex partners. A probability sample of 195 Grindr-using YMSM in Southern California were administered an anonymous online survey to assess patterns of and motivations for Grindr use in order to inform development and tailoring of smartphone-based HIV prevention for YMSM. The number one reason for using Grindr (29 %) was to meet “hook ups.” Among those participants who used both Grindr and online dating sites, a statistically significantly greater percentage used online dating sites for “hook ups” (42 %) compared to Grindr (30 %). Seventy percent of YMSM expressed a willingness to participate in a smartphone app-based HIV prevention program. Development and testing of smartphone apps for HIV prevention delivery has the potential to engage YMSM in HIV prevention programming, which can be tailored based on use patterns and motivations for use.     

Homophobia is Associated with Sexual Behavior that Increases Risk of Acquiring and Transmitting HIV Infection Among Black Men Who Have Sex with Men

We investigated whether the experience of homophobic events increases the odds of engaging in unprotected anal intercourse (UAI) among black men who have sex with men (MSM) and whether social integration level buffered the association. Participants (N = 1,154) reported homophobic events experienced in the past 12 months. Social integration measures included social support, closeness with family members and friends, attachment to the black gay community, openness about sexuality within religious communities, and MSM social network size. Logistic regression analyses indicated that experiencing homophobia was associated with (1) UAI among men not previously diagnosed with HIV and (2) sexual HIV transmission risk behavior among men who knew they were HIV-infected. None of the social integration measures buffered these associations. Homophobia may promote acquisition and transmission of HIV infection among black MSM. Interventions are needed to reduce homophobia experienced by black MSM.     

Patterns of Social Affiliations and Healthcare Engagement Among Young,Black, Men Who Have Sex With Men

Little work has examined how individuals’ social affiliations—the venues in which they meet friends and engage in informal social interaction—influence their engagement with public health services. We investigate how links to these local places shape access to information and exposure to health-seeking behavior. Using longitudinal data from a respondent-driven sample of 618 young black men who have sex with men (YBMSM) in Chicago, we identify different sets of social venues that connect YBMSM. We then examine how YBMSM’s connections within this network influence their receipt of HIV prevention and treatment services and knowledge of pre-exposure prophylaxis (PrEP). Our results show that YBMSM’s positions within Chicago’s venue network shape the types of health-related services they access, net of demographic, structural, and community covariates. Men with affiliations that are linked to the city’s gay enclave are most likely to know about PrEP, while men with affiliations that are predominately in the black community demonstrate improved HIV treatment outcomes. Outreach engaging MSM beyond venues in gay enclaves is needed.     

HIV and Syphilis Prevalence and Associated Factors Among Young Men Who Have Sex with Men in 4 Cities in China

To know the status of HIV and syphilis infection, and the correlates for HIV and syphilis prevalence among YMSM in China. 150 YMSM were recruited in Beijing, Harbin, Zhengzhou and Chengdu respectively and investigated with questionnaire, HIV and syphilis testing. The prevalence of HIV infection, syphilis infection and concurrent infection of HIV and syphilis was 6.7, 8.3, 1.5% respectively. HIV infection was associated with numerous factors including education level of high school, not being student, etc. Syphilis infection was associated with not being student and having had vaginal intercourse. The prevalence of HIV and Syphilis are high among YMSM in cities in China. Preventive interventions should be developed for controlling HIV spreading among YMSM urgently.     

Unmet HIV Service Needs Among Black Men Who Have Sex with Men in the United States

The National HIV/AIDS Strategy (NHAS) clearly emphasized the need to provide services to black men who have sex with men (MSM). However, there are no estimates of the unmet HIV-related service delivery needs among black MSM. We estimate that of 195,313 black MSM living with HIV in the US, 50,196 were not yet diagnosed, and 145,118 were aware of their seropositivity (of whom 67,625 were not linked to care and 77,493 were linked to care). Also, of those already diagnosed, ~43,390 had undetectable viral load and 101,728 had detectable viral load. Approximately 19,545 of diagnosed black MSM engage in unprotected risk behavior in serostatus-discordant partnerships. The cost of delivering services needed to meet the NHAS goals is ~$2.475 billion in 2011 U.S. dollars. Mathematical modeling suggests that provisions of these services would avert 6213 HIV infections at an economically favorable cost of $20,032 per quality-adjusted life year saved.     

HIV/AIDS-Related Stigmatizing and Discriminatory Attitudes and Recent HIV Testing Among Men Who Have Sex With Men in Beijing

This study assessed the correlates of recent HIV testing and HIV/AIDS-related stigmatizing and discriminatory attitudes among men who have sex with men (MSM) in Beijing, China. A cross-sectional study probed demographics, sexual and drug use behaviors, HIV testing, and prevention services. Of 500 participants, 39.3% recently received a test for HIV. Recent testing was independently associated with expressing lower levels of HIV/AIDS-related stigmatizing and discriminatory attitudes, more male sex partners, no female sexual partners and knowing HIV status of their last male partner. Expressing lower levels of HIV/AIDS-related stigmatizing and discriminatory attitudes was independently associated with recent testing, younger age, and knowing HIV status of their last male partner. This study revealed that HIV/AIDS-related stigmatizing and discriminatory attitudes were common and inversely associated with recent HIV testing. Low levels of testing highlighted the urgent needs to reduce HIV/AIDS-related stigma and discrimination and expand HIV testing among MSM in Beijing.     

Perceived Likelihood of Using HIV Pre-exposure Prophylaxis Medications Among Young Men Who Have Sex with Men

Pre-exposure prophylaxis (PrEP) is a new strategy for reducing the risk of HIV infection; however, questions about the likelihood of use remain. As part of an ongoing longitudinal study of YMSM, interest in PrEP use under various conditions of side-effects, dosing, and effectiveness were assessed. Participants aged 16–20 living in Chicago and the surrounding areas were recruited beginning December 2009, using a modified form of respondent driven sampling. A cross-sectional sample of 171 HIV negative YMSM interviewed approximately 6 months after initial enrollment was analyzed. This sample was somewhat interested in adopting PrEP as an HIV prevention strategy, particularly if the dosing and side-effects burden was low and the perceived benefits were high. PrEP interest was unrelated with drug use and number of sexual partners, but negatively correlated with number of unprotected anal sex acts. The scale was positively associated with intentions for use in specific risk situations.     

HIV Prevention and Sex Behaviors as Organizing Mechanisms in a Facebook Group Affiliation Network Among Young Black Men Who Have Sex with Men

Online social networking sites (SNS)—the Internet-based platforms that enable connection and communication between users—are increasingly salient social environments for young adults and, consequently, offer tremendous opportunity for HIV behavioral research and intervention among vulnerable populations like young men who have sex with men (YMSM). Drawing from a cohort of 525 young Black MSM (YBMSM) living in Chicago, IL, USA April 2014–May 2015, we conducted social network analysis, estimating an exponential random graph model (ERGM) to model YBMSM’s group affiliations on Facebook in relation to their sex behaviors and HIV prevention traits. A group’s privacy setting—public, closed, or secret—was also modeled as a potential moderator of that relationship. Findings reveal that HIV positive individuals were more likely to affiliate with Facebook groups, while those who engaged in group sex were less likely to do so. When it came to the privacy of groups, we learned that HIV positive individuals tended not to belong to groups with greater privacy (e.g., closed and secret groups), while individuals who engaged in group sex and those who engaged in regular HIV testing were more likely to belong to those groups. Results also showed that individuals who engaged in condomless sex showed significant signs of clustering around the same set of groups. HIV positive individuals, on the other hand, were significantly less likely to demonstrate clustering. Implications for interventions and future research are discussed.     

Structural Bridging Network Position is Associated with HIV Status in a Younger Black Men Who Have Sex with Men Epidemic

Younger Black men who have sex with men (BMSM) ages 16–29 have the highest rates of HIV in the United States. Despite increased attention to social and sexual networks as a framework for biomedical intervention, the role of measured network positions, such as bridging and their relationship to HIV risk has received limited attention. A network sample (N = 620) of BMSM respondents (N = 154) and their MSM and transgendered person network members (N = 466) was generated through respondent driven sampling of BMSM and elicitation of their personal networks. Bridging status of each network member was determined by a constraint measure and was used to assess the relationship between this bridging and unprotected anal intercourse (UAI), sex-drug use (SDU), group sex (GS) and HIV status within the network in South Chicago. Low, moderate and high bridging was observed in 411 (66.8 %), 81 (13.2 %) and 123 (20.0 %) of the network. In addition to age and having sex with men only, moderate and high levels of bridging were associated with HIV status (aOR 3.19; 95 % CI 1.58–6.45 and aOR 3.83; 95 % CI 1.23–11.95, respectively). Risk behaviors observed including UAS, GS, and SDU were not associated with HIV status, however, they clustered together in their associations with one another. Bridging network position but not risk behavior was associated with HIV status in this network sample of younger BMSM. Socio-structural features such as position within the network may be important when implementing effective HIV prevention interventions in younger BMSM populations.     

Early Male Partnership Patterns,Social Support,and Sexual Risk Behavior Among Young Men Who Have Sex with Men

Few data exist on the early sexual behavior patterns of contemporary young men who have sex with men (YMSM), the social context of these patterns, and which of these factors influence risk for HIV and other sexually transmitted infections (STI). We enrolled 94 YMSM (age 16–30) into a 1-year cohort study with serial online retrospective surveys and HIV/STI testing. The first three partnerships of YMSM were characterized by relatively high rates of unprotected anal sex and a rapidly expanding sexual repertoire, but also increasing rates of HIV status disclosure. During follow-up, 17 % of YMSM reported any nonconcordant unprotected anal intercourse (NCUAI) and 15 % were newly diagnosed with HIV/STI. Sex education in high school and current maternal support were protective against HIV/STI, while isolation from family and friends was associated with recent NCUAI. Social support—including from parents, peers, and school-based sex education—may help mitigate HIV/STI risk in this population.     

HIV and STI Testing and Related Factors Among Men Who Have Sex with Men in Estonia

HIV and sexually transmitted infections (STI) testing rates among men who have sex with men (MSM) in Estonia are low. We collected data from 265 MSM in a national, online survey. Lifetime HIV testing was related to risky sexual behaviors and contacts with health care services, while lifetime STI testing was related only to contacts with health care services. In addition, some personal values were significant predictors of testing. For example, high achievement (personal success through demonstrating competence according to social standards) had a negative impact on lifetime HIV testing, and high interpersonal conformity (avoiding upsetting others) had a negative impact on lifetime STI testing. The results demonstrate the need to develop gay-friendly health services and to recognize the role of personal values and individual differences in values when designing attractive interventions to increase HIV/STI testing rates among MSM.     

Cost-utility of HIV Testing Programs Among Men Who Have Sex with Men in the United States

Few groups in the United States (US) are as heavily affected by HIV as men who have sex with men (MSM), yet many MSM remain unaware of their infection. HIV diagnosis is important for decreasing onward transmission and promoting effective treatment for HIV, but the cost-effectiveness of testing programs is not well-established. This study reports on the costs and cost-utility of the MSM Testing Initiative (MTI) to newly diagnose HIV among MSM and link them to medical care. Cost and testing data in 15 US cities from January 2013 to March 2014 were prospectively collected and combined to determine the cost-utility of MTI in each city in terms of the cost per Quality Adjusted Life Years (QALY) saved from payer and societal perspectives. The total venue-based HIV testing costs ranged from $18,759 to $564,284 for nine to fifteen months of MTI implementation. The cost-saving threshold for HIV testing of MSM was $20,645 per new HIV diagnosis. Overall, 27,475 men were tested through venue-based MTI, of whom 807 (3 %) were newly diagnosed with HIV. These new diagnoses were associated with approximately 47 averted HIV infections. The cost per QALY saved by implementation of MTI in each city was negative, indicating that MTI venue-based testing was cost-saving in all cities. The cost-utility of social network and couples testing strategies was, however, dependent on whether the programs newly diagnosed MSM. The cost per new HIV diagnosis varied considerably across cities and was influenced by both the local cost of MSM testing implementation and by the seropositivity rate of those reached by the HIV testing program. While the cost-saving threshold for HIV testing is highly achievable, testing programs must successfully reach undiagnosed HIV-positive individuals in order to be cost-effective. This underscores the need for HIV testing programs which target and engage populations such as MSM who are most likely to have undiagnosed HIV to maximize programmatic benefit and cost-utility.     

Having Supportive Social Relationships is Associated with Reduced Risk of Unrecognized HIV Infection Among Black and Latino Men who Have Sex with Men

We examined the hypothesis that black and Latino men who have sex with men (MSM) who have supportive social relationships with other people are less likely to have unrecognized HIV infection compared with MSM of color who report lower levels of social support. We interviewed 1286 black and Latino MSM without known HIV infection in three metropolitan areas who were recruited using respondent driven sampling. Participants completed a computer-administered questionnaire and were tested for HIV. Unrecognized HIV infection was found in 118 men (9.2%). MSM who scored higher on the supportive relationship index had significantly lower odds of testing HIV-positive in the study. The mediation analysis identified two possible behavioral pathways that may partially explain this association: men who had strong supportive relationships were more likely to have had a test for HIV infection in the past 2 years and less likely to have recently engaged in high-risk sexual behavior. The findings illuminate the protective role of social relationships among MSM of color in our sample.     

Multiple Dimensions of Stigma and Health Related Factors Among Young Black Men Who Have Sex with Men

This study is among the first to examine the association between multiple domains of HIV-related stigma and health-related correlates including viral load and medication adherence among young Black men who have sex with men (N = 92). Individual logistic regressions were done to examine the hypothesized relationships between HIV-related stigma and various health and psychosocial outcomes. In addition to examining total stigma, we also examined four domains of HIV stigma. Findings revealed the various domains of stigma had differential effects on health-related outcomes. Individuals who reported higher levels of total stigma and personalized stigma were less likely to be virally suppressed (OR 0.96, 95 % CI 0.91–1.00 and OR 0.50, 95 % CI 0.25–1.02, respectively). Concerns about public attitudes toward HIV were positively related to medication adherence (OR 2.18, 95 % CI 1.20–3.94) and psychological distress (OR 5.02, 95 % CI 1.54–16.34). The various domains of HIV stigma differentially affected health and psychosocial outcomes, and our findings suggest that some forms of HIV stigma may significantly affect viral load and medication adherence among this population. Stigma-informed approaches to care and treatment are needed, along with incorporated psychological and social supports.     

Racial Mixing and HIV Risk Among Men Who Have Sex with Men

We conducted a cross-sectional survey of MSM using a time-location-sampling design in San Francisco during 2007–2008. The investigation focused on the selection of sexual partners, partner preferences, perceptions of HIV risk, and social mixing with respect to race/ethnicity. The sample of 1,142 MSM was 56% White, 22% Latino, 14% Asian, and 9% Black and reported on 3,532 sexual partnerships. Black MSM had a significant, three-fold higher level of same race sexual partnering than would be expected by chance alone (i.e., in the absence of selective forces with respect to race among partners). Black MSM were reported as the least preferred as sexual partners, believed at higher risk for HIV, counted less often among friends, were considered hardest to meet, and perceived as less welcome at the common venues that cater to gay men in San Francisco by other MSM. Our findings support the hypothesis that the sexual networks of Black MSM, constrained by the preferences and attitudes of non-Blacks and the social environment, are pushed to be more highly interconnected than other groups with the potential consequence of more rapid spread of HIV and a higher sustained prevalence of infection. The racial disparity in HIV observed for more than a decade will not disappear until the challenges posed by a legacy of racism towards Blacks in the US are addressed.