Factors associated with HIV testing frequency among gay and bisexual men who have sex with men in the United States Open Access

Abstract

Background: Cisgender gay, bisexual, and other men who have sex with men (GBMSM) account for a disproportionate number of new HIV diagnoses in the United States each year. Regular testing has been shown to be an impactful HIV prevention strategy. We sought to understand factors associated with HIV testing frequency among a sample of cisgender GBMSM in the United States.

Methods: Data were collected in the 2022–2023 cycle of the American Men's Internet Survey. This analysis was restricted to participants aged >15 years reporting anal sex with another man in the past 12 months, never having been diagnosed with HIV, no history of PrEP use, and living in the 50 states or District of Columbia (D.C.). HIV testing frequency was based on number of self-reported tests in the past two years: greater than annually (>2 tests), annually (2 tests), and less than annually (<2 tests). Crude and adjusted prevalence odds ratios (POR) were estimated using multinomial logistic regression.

Results: A total of 1,673 participants were included in this analysis. Most were 40 or older (54.9%) and non-Hispanic white (70.6%). Overall, 59%, 19%, and 22% reported less than annual, annual, and greater than annual HIV testing, respectively. In adjusted analyses, GBMSM 25-29, 30-29, and 40+ years old were more likely to test greater than annually (aPOR (95% CI): 1.99 (1.08, 3.67); 2.09 (1.22, 3.58); 2.03 (1.21, 3.40), respectively) compared to 15–24-year-old GBMSM. Non-Hispanic Black and Hispanic individuals were more likely to test greater than annually (aPOR (95% CI): 2.50 (1.58, 3.94); 2.20 (1.44, 3.35), respectively) than non-Hispanic White individuals. Those with a HS diploma or equivalent were less likely to test greater than annually (aPOR (95% CI): 0.54 (0.34, 0.85)) than individuals with a college degree or postgraduate education. In adjusted analyses, other factors associated with frequency of testing were education, urbanicity of residence, and PrEP eligibility status.

Discussion: Testing frequency is aligned with HIV risk for many respondents; however, there are still disparities in the HIV testing frequencies of GBMSM of varying sociodemographic backgrounds. Overall, there is a need for tailored testing mechanisms and the expansion of testing options to reduce barriers to uptake.

Table of Contents

INTRODUCTION .......................................................................................................................................... 1

METHODS..................................................................................................................................................... 3

PARTICIPANTS AND PROCEDURES............................................................................................................................... 3

MEASURES.................................................................................................................................................................. 3 

PRIMARY ANALYSES .................................................................................................................................................. 4 

SUPPLEMENTAL ANALYSES ........................................................................................................................................ 4

RESULTS....................................................................................................................................................... 5

STUDY SAMPLE .......................................................................................................................................................... 5 

FACTORS ASSOCIATED WITH ANNUAL TESTING......................................................................................................... 5 

FACTORS ASSOCIATED WITH GREATER THAN ANNUAL TESTING............................................................................... 6

DISCUSSION ................................................................................................................................................. 6

TABLES & FIGURES .................................................................................................................................. 10

TABLE 1: DISTRIBUTION OF SOCIODEMOGRAPHIC FACTORS OF GAY AND BISEXUAL MEN WHO HAVE SEX WITH MEN IN THE UNITED STATES WITH NO PRIOR HISTORY OF PREP USE, STRATIFIED BY TESTING FREQUENCY ................... 10 

TABLE 2: FREQUENCY OF HIV TESTING BY PREP ELIGIBILITY AMONG GAY AND BISEXUAL MEN WHO HAVE SEX WITH MEN IN THE UNITED STATES WITH NO PRIOR HISTORY OF PREP USE.............................................................. 12 

TABLE 3: CRUDE AND ADJUSTED PREVALENCE ODDS RATIOS FOR FREQUENCY OF HIV TESTING FROM A MULTINOMIAL LOGISTIC REGRESSION MODEL AMONG GAY AND BISEXUAL MEN WHO HAVE SEX WITH MEN IN THE UNITED STATES WITH NO PRIOR HISTORY OF PREP USE........................................................................................... 13

 FIGURE 1: FOREST PLOT OF ADJUSTED PREVALENCE ODDS RATIOS FOR PREDICTORS OF ANNUAL TESTING AMONG GAY AND BISEXUAL MEN WHO HAVE SEX WITH MEN IN THE UNITED STATES WITH NO PRIOR HISTORY OF PREP USE, COMPARED TO LESS THAN ANNUAL TESTING ............................................................................................................ 15

FIGURE 2: FOREST PLOT OF ADJUSTED PREVALENCE ODDS RATIOS FOR PREDICTORS OF GREATER THAN ANNUAL TESTING AMONG GAY AND BISEXUAL MEN WHO HAVE SEX WITH MEN IN THE UNITED STATES WITH NO PRIOR HISTORY OF PREP USE, COMPARED TO LESS THAN ANNUAL TESTING ....................................................................... 16

REFERENCES ............................................................................................................................................. 17

APPENDIX................................................................................................................................................... 20

SUPPLEMENTAL TABLES........................................................................................................................................... 20 

Table S1: Supplemental Model 1 - Crude and adjusted prevalence odds ratios from a multinomial logistic regression model among gay and bisexual men who have sex with men with a history of PrEP use who were not using PrEP at the time of the survey nor had used it in the past 12 months ................................................ 20

Table S2: Supplemental Model 2 - Crude and adjusted prevalence odds ratios from a multinomial logistic regression model among gay and bisexual men who have sex with men not living with HIV, including those who were taking PrEP at the time of the survey ................................................................................................. 23

SUPPLEMENTAL ANALYSES RESULTS .................................................................................................................... 26

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health GLBT Studies Health Sciences, Epidemiology
Keyword	HIV testing GBMSM MSM
Committee Chair / Thesis Advisor	Jones, Jeb, Emory University

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