HIV prevention services received at health care and HIV test providers by young men who have sex with men: an examination of racial disparities

Explaining inequity in knowledge, attitude, and services related to HIV/AIDS: a systematic review

BACKGROUND

Equitable service provision and coverage are important responses to end the threat of the HIV/AIDS pandemic. Understanding inequity supports policies and programmes to deliver tailored interventions. There is continuous evidence generation on inequity in HIV/AIDS services. However, there was a lack of evidence on the global picture of inequity in behavioural and biomedical services related to HIV/AIDS. This systematic review assessed inequities in knowledge, attitude, HIV testing, and ART coverage across individual-level social groups and multiple (dis)advantage categories.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, with a PROSPERO registration number CRD42024521247. The risk of bias was assessed by using Hoy et al's and Joanna Brigg's quality appraisal checklists for cross-sectional quantitative and qualitative studies, respectively. The search date was from inception to the final database search date (May 29, 2023). The included articles were either quantitative or qualitative studies. We used mixed-methods approach to analyse the data from the review articles. Quantitative descriptive analysis was conducted to estimate frequency of articles published from different countries around the world. Qualitative content analysis of the findings from the original studies was conducted using the PROGRESS plus framework which stands for: place of residence, occupation or employment status, gender, religion, education status, socioeconomic status, and social capital.

RESULTS

Out of 6,029 articles that were accessed and screened, only 72 articles met the inclusion criteria. More articles on HIV-related equity in knowledge, attitude, testing, and ART were published in developed countries than in developing countries. Individuals from higher-income households had better knowledge about HIV/AIDS. Unfavourable attitudes towards people living with HIV and HIV/AIDS-associated stigma were common among women. HIV/AIDS service coverage (HIV testing or ART coverage) was higher among richer and urban residents. HIV/AIDS-associated stigma and lower levels of knowledge about HIV/AIDS were observed among multiple disadvantageous groups due to the intersection of two or more identities.

CONCLUSIONS

The current review revealed that there have been disparities in HIV/AIDS services between social classes. Ending service disparity towards the global threat of HIV/AIDS demands tailored interventions based on socially disadvantaged groups (e.g., poor, rural dwellers, and women) and intersectional determinants. There is a need to understand the deep-rooted causes of inequity and the challenges that an equity-oriented system faces over time. More studies on inequity are needed, including intersectional inequity, which has been rarely studied in developing countries.

HIV Testing Among Black and Hispanic/Latino Men Who Have Sex with Men in New York City: A Mixed-Methods Study

Black and Latino men who have sex with men (BLMSM) accounted for 53% of males newly diagnosed with HIV in New York City (NYC) in 2015. Despite increased HIV testing efforts with BLMSM in the U.S. and specifically in areas like NYC with high rates of HIV, data show suboptimal testing among BLMSM in some high-prevalence areas of the country. Few reports describe the HIV testing perspectives of BLMSM at risk of HIV acquisition. We sought to obtain information from BLMSM at possible risk of HIV infection to learn about their HIV testing perspectives. During 2011-2012, we obtained baseline and 3-month follow-up computer questionnaire data and in-depth interview data from self-identified BLMSM in the NYC area who had not been recently tested for HIV. Quantitative demographic data were analyzed using SAS. Qualitative interview responses regarding personal experiences and thoughts about HIV testing were analyzed using applied thematic analysis. Overall, 109 BLMSM participated; 51 (46.85%) had never been tested for HIV; 43 (39.4%) were aged 18-29 years; 51 (46.8%) reported condomless sex at last sex. Qualitative analyses revealed three major themes: (1) perceptions on the NY State HIV opt-out HIV testing law; (2) HIV testing experiences; and (3) HIV testing and its role in the MSM community. These findings provide insight into HIV testing approaches and can be used to help strengthen HIV testing strategies for BLMSM in NYC.

Young Black Gay/Bisexual and Other Men Who Have Sex With Men: A Review and Content Analysis of Health-Focused Research Between 1988 and 2013

Black young gay, bisexual, and other men who have sex with men (YGBMSM) are at high risk for negative health outcomes, though this population is underrepresented in the health literature. An extensive literature review and content analysis of health-related peer-reviewed articles (1988-2013) was conducted that targeted Black YGBMSM, examining five content areas: sexual health, health care, substance use, psychosocial functioning, and sociostructural factors. A coding sheet was created to collect information on all content areas and related subtopics and computed descriptive statistics. Out of 54 articles, most were published after 2004 ( N = 49; 90.7%) and addressed some aspect of sexual health ( N = 50; 92.6%). Few articles included content on psychosocial functioning, including bullying/harassment, suicide, and racial/ethnic identity. Data on health care delivery/receipt and health insurance were underrepresented; tobacco use and substance abuse were seldom addressed. Important sociostructural factors, including sexual networks and race-based discrimination, were poorly represented. Last, there was a noteworthy deficit of qualitative studies and research exploring intersectional identity and health. This review concludes that studies on Black YGBMSM health places sex at the forefront to the neglect of other critical health domains. More research is needed on the diverse health issues of a vulnerable and underexamined population.

Motivators and barriers for HIV testing among men who have sex with men in Sweden

AIMS AND OBJECTIVES

To explore motivators and barriers to HIV testing and to assess the factors associated with testing among men who have sex with men.

BACKGROUND

Previous research has considered fear, worries and structural barriers as hindrances to HIV testing among men who have sex with men. However, few studies have included assessments of actual HIV testing when exploring barriers or motivators for such testing.

DESIGN

The design of the study was a stratified cross-sectional online survey (n = 2373).

METHOD

Factor analysis was conducted to analyse the barriers and motivators for HIV testing. Logistic regression analysis was conducted to assess predictors for HIV testing.

RESULTS

Many men who have sex with men test for HIV regularly, and specific reasons for testing were having unprotected sex or starting/ending a relationship. A lack of awareness and a perception of being at low risk for exposure were common reasons for never being tested. Fear and anxiety as well as barriers related to the use of test services remain important hindrances for testing. Predictors associated with having been tested within the past 12 months were: younger age (15-25 years old compared with 47+); knowledge on where to take an HIV test on short notice as well as having talked with a counsellor, having received condoms for free, or having had unprotected anal intercourse with casual partners within the last 12 months.

CONCLUSION

Easily accessible test services offering testing and counselling on short notice should be available for all men who have sex with men. Outreach activities, distribution of free condoms and testing at venues where men who have sex with men meet are important prevention add-ons that can contribute to increased awareness about HIV and testing.

RELEVANCE TO CLINICAL PRACTICE

Test services must ensure confidentiality and health care professionals who meet men who have sex with men for testing need competency with regards to men who have sex with men sexual health needs.

HIV testing and preventive services accessibility among men who have sex with men at high risk of HIV infection in Beijing, China

The HIV epidemic among men who have sex with men (MSM) has been increasing at an alarming rate in most areas of China in recent years. Many Chinese MSM still lack sufficient access to HIV prevention services, despite ongoing scale-up of comprehensive HIV testing and intervention services. The purpose of this study was to investigate utilization of HIV testing and prevention services, and related factors that influence the MSM people to access HIV test or other services to prevent HIV among MSM in Beijing, China.Three successive cross-sectional surveys of MSM were conducted in Beijing from September 2009 to January 2010, September 2010 to January 2011, and September 2011 to January 2012. Demographic and behavioral data were collected and analyzed. Blood samples were tested for HIV and syphilis. Three models were established to analyze factors associated with HIV testing and preventive services.Of the 1312 participants, prevalence of HIV and syphilis was 7.9% and 15.4%, respectively. Sixty-nine percent ever had an HIV test, 56.2%, 78.7%, and 46.1% received HIV test, free condom/lubricants, and sexually transmitted infection services in the past 12 months (P12M), respectively. MSM with larger social networks and who knew someone infected with HIV were more likely to receive HIV testing and preventive services; lower degrees of stigma and discriminatory attitudes toward HIV/AIDS were positively associated with having an HIV test, whereas unprotected anal intercourse in the past 6 months (P6M) was associated with less preventive services participation. The most reported barriers to HIV testing were fear of testing HIV positive (79.3%) and perceiving no risk for HIV (75.4%). Almost all participants felt that ensuring confidentiality would encourage more MSM to have an HIV test. The two main reasons for not seeking HIV test was not knowing where to go for a test (63.2%) and perceiving low risk of HIV infection (55.1%).Given a high prevalence of HIV, syphilis, and risky behaviors and a relatively low HIV testing rate among MSM in Beijing, more efforts are urgently needed to address barriers to HIV testing and improve accessibility of prevention services.

Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States

Structural-level factors have contributed to the substantial disproportionate rates of HIV among Black men who have sex with men (BMSM) in the United States. Despite insufficient HIV testing patterns, however, there is a void in research investigating the relationship between structural factors and access to HIV testing and prevention services among BMSM. Building on previous scholarly work and incorporating a dynamic social systems conceptual framework, we conducted a comprehensive review of the literature on structural barriers to HIV testing and prevention services among BMSM across four domains: healthcare, stigma and discrimination, incarceration, and poverty. We found that BMSM experience inadequate access to culturally competent services, stigma and discrimination that impede access to services, a deficiency of services in correctional institutions, and limited services in areas where BMSM live. Structural interventions that eliminate barriers to HIV testing and prevention services and provide BMSM with core skills to navigate complex systems are needed.

HIV infection and testing among Latino men who have sex with men in the United States: the role of location of birth and other social determinants

BACKGROUND

In the United States, Latino men who have sex with men (MSM) are disproportionately affected by HIV. Latino MSM are a diverse group who differ culturally based on their countries or regions of birth and their time in the United States. We assessed differences in HIV prevalence and testing among Latino MSM by location of birth, time since arrival, and other social determinants of health.

METHODS

For the 2008 National HIV Behavioral Surveillance System, a cross-sectional survey conducted in large US cities, MSM were interviewed and tested for HIV infection. We used generalized estimating equations to test associations between various factors and 1) prevalent HIV infection and 2) being tested for HIV infection in the past 12 months.

RESULTS

Among 1734 Latino MSM, HIV prevalence was 19%. In multivariable analysis, increasing age, low income, and gay identity were associated with HIV infection. Moreover, men who were U.S.-born or who arrived ≥5 years ago had significantly higher HIV prevalence than recent immigrants. Among men not reporting a previous positive HIV test, 63% had been tested for HIV infection in the past 12 months; recent testing was most strongly associated with having seen a health care provider and disclosing male-male attraction/sexual behavior to a health care provider.

CONCLUSIONS

We identified several social determinants of health associated with HIV infection and testing among Latino MSM. Lower HIV prevalence among recent immigrants contrasts with higher prevalence among established immigrants and suggests a critical window of opportunity for HIV prevention, which should prioritize those with low income, who are at particular risk for HIV infection. Expanding health care utilization and encouraging communication with health care providers about sexual orientation may increase testing.

Participation of HIV prevention programs among men who have sex with men in two cities of China--a mixed method study

Background

Although various HIV prevention programs targeting men who have sex with men (MSM) are operating in China, whether and how these programs are being utilized is unclear. This study explores participation of HIV prevention programs and influencing factors among MSM in two cities in China.

Methods

This is a mixed-method study conducted in Beijing and Chongqing. A qualitative study consisting of in-depth interviews with 54 MSM, 11 key informants, and 8 focus group discussions, a cross-sectional survey using respondent-driven sampling among 998 MSM were conducted in 2009 and 2010 respectively to elicit information on MSM’s perception and utilization of HIV prevention programs. Qualitative findings were integrated with quantitative multivariate factors to explain the quantitative findings.

Results

Fifty-six percent of MSM in Chongqing and 75.1% in Beijing ever participated in at least one type of HIV prevention program (P=0.001). Factors related to participation in HIV prevention programs included age, ethnicity, income, HIV risk perception, living with boyfriend, living in urban area, size of MSM social network, having talked about HIV status with partners, and knowing someone who is HIV positive. Reasons why MSM did not participate in HIV prevention programs included logistical concerns like limited time for participation and distance to services; program content and delivery issues such as perceived low quality services and distrust of providers; and, cultural issues like HIV-related stigma and low risk perception.

Conclusions

The study shows that there is much room for improvement in reaching MSM in China. HIV prevention programs targeting MSM in China may need to be more comprehensive and incorporate the cultural, logistic and HIV-related needs of the population in order to effectively reach and affect this population’s risk for HIV.

Prevalence and determinants of recent HIV testing among sexually active men who have sex with men in the St. Louis metropolitan area, Missouri, 2008

BACKGROUND

New human immunodeficiency virus (HIV) diagnoses in the St. Louis metropolitan area, MO, occur predominantly among men who have sex with men (MSM). The Centers for Disease Control and Prevention recommends HIV testing at least annually for sexually active MSM. We examined prevalence and factors associated with recent HIV testing among MSM in the St. Louis area.

METHODS

The 2008 National HIV Behavioral Surveillance system recruited men in 21 US metropolitan areas through venue-based, time-space sampling. Men were interviewed for behavioral risks and testing history. The analysis included men in St. Louis who had engaged in male-male sex during the previous year and excluded men who had tested HIV-positive >12 months before the interviews. Factors associated with testing during the previous 12 months were identified using log-binomial regression.

RESULTS

Among 339 MSM, 198 (58%) had been tested during the previous 12 months. MSM were more likely to have been tested if they were black (adjusted prevalence ratio [APR]: 1.6; 95% confidence interval [CI]: 1.0-2.5); had visited a health care provider during the previous 12 months (APR: 1.6; 95% CI: 1.3-2.1); or had ever disclosed same-sex attractions or male-male sex to health care providers (APR: 1.6; 95% CI: 1.2-2.0). Of the 141 men who were untested within 12 months, 89 (63%) attributed not testing to perceived low risk.

CONCLUSIONS

Nearly half of sexually active MSM in this analysis had not been tested for HIV during the previous year. Annual visits to health care providers during which sexual risk is discussed are likely to promote testing among MSM.

Results from two online surveys comparing sexual risk behaviors in Hispanic, black, and white men who have sex with men

Many men who have sex with men (MSM) are among those who increasingly use the internet to find sexual partners. Few studies have compared behavior by race/ethnicity in internet-based samples of MSM. We examined the association of race/ethnicity with HIV risk-related behavior among 10,979 Hispanic, black, and white MSM recruited online. Significant variations by race/ethnicity were found in: age, income level, sexual orientation, number of lifetime male and female sexual partners, and rates of unprotected anal intercourse (UAI). Black and Hispanic men were more likely to report anal intercourse during the last sexual encounter, but white men were more likely to report UAI. In multivariate analysis, UAI was associated with HIV infection and sex with a main partner. Significant risk behavior variations by race/ethnicity were found. Research is needed to better target online interventions to MSM who engage in UAI or have other risk factors for transmitting or acquiring HIV.

Epidemiologic data on young men of color who have sex with men

Young men of color who have sex with men (YMSM of color) have been disproportionately affected by the HIV/AIDS epidemic in the United States. Between 2001 and 2006, HIV/AIDS diagnoses increased 93.1% among African-American MSM aged 13-24 and 45.8% among Latino MSM aged 13-24. Many multisite studies have yielded valuable information on the behaviors associated with HIV infection in adolescents, MSM, African-Americans, and Latinos. Studies among adolescents found a high prevalence of risky sexual behaviors, including having multiple partners and unprotected intercourse and frequent substance use. Multisite studies of MSM also found frequent reports of alcohol and drug abuse, and one study found that nearly one-half (48%) of HIV-positive MSM were unaware of their infection. Similarly, two multisite studies of YMSM found high rates of unprotected sex, substance use, and HIV-infection among YMSM of color. Recognizing these challenges, the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA) funded the first multisite study to improve engagement, linkage to HIV care, and retention in care for HIV-positive YMSM of color. The objective of this article is to review the epidemiologic data on HIV-positive YMSM of color from surveillance and multisite studies in order to identify the needs of this population and the gaps in the literature.

A critical literature review to identify possible causes of higher rates of HIV infection among young black and Latino men who have sex with men

Black and Latino young men who have sex with men (YMSM) are disproportionately impacted by HIV infection; however, the reason for this disparity is unclear. To identify possible causes of the higher rates of HIV infection in this population, data from studies of HIV infection and risk-related behaviors among black and Latino YMSM were used to evaluate a series of hypotheses adapted from Millett et al's literature review that might explain the disparity. High rates of HIV infection might be attributable to unrecognized HIV infection, social/sexual networks, and a history of childhood sexual abuse; however, they were not attributable to risk-related behaviors. More research is needed to understand the risk factors for HIV infection and how to address them in HIV prevention interventions.

Offering of HIV screening to men who have sex with men by their health care providers and associated factors

OBJECTIVE

in 2006, the US Centers for Disease Control and Prevention (CDC) recommended offering HIV testing at least annually to men who have sex with men (MSM), but few studies describe the extent to which routine offering occurred after 2006.

METHODS

data were collected from March to April 2009 using an online survey of US MSM aged ≥18 years. Multivariable logistic regression estimated the odds of being offered HIV testing for demographic factors and for having disclosed male-male sex behavior to the health care provider.

RESULTS

of 4620 MSM reporting visiting a health care provider in the past year, 1385 (30%) were offered HIV testing. Being offered testing was associated with disclosing male-male sex to the provider (decreasing odds by age from age 20: adjusted odds ratio [aOR] 19.22, 95% confidence interval [CI]: 15.79-23.41) and other demographic factors.

CONCLUSIONS

less than one third of the MSM visiting a provider reported being offered HIV testing. Providers should actively assess male-male sex risk to potentially improve offering of HIV screenings.