Factors that may explain lower HIV testing among young MSM as compared to older MSM Open Access

Abstract

HIV testing is an important first step in identifying, diagnosing, and treating those who are HIV

infected. HIV testing prevalence has increased for the general population of men who have sex

with men (MSM). However, progress in testing among younger MSM has lagged, leading to a

disproportionate amount of missed diagnoses among this subpopulation. In this study, we

analyzed a population of MSM living in the United States who participated in the 2016

American Men’s Internet Survey (AMIS) in order to explore factors that may explain the

difference in HIV testing between younger and older MSM. We analyzed data on 10,052

participants, 2,684 of whom were 15-24 years old. We conducted univariate and bivariate

analyses, as well as logistic regression modeling to estimate effect modification by age for

factors associated with the outcome of lack of HIV testing. Among 15-24 year old MSM, the

crude odds ratio of never having been HIV tested for those that reported lack of STI testing in the

past 12 months (OR = 31.07, 95% Confidence Interval: 22.25, 43.39) was statistically stronger

(interaction 𝛽 p-value = 0.007) compared to the unadjusted odds ratio among those 25 years or

older (OR = 13.76, 95% CI: 9.90, 19.11). A statistically significant effect modification was also

observed for the factor of reporting that a healthcare provider did not offer an HIV test in the past

12 months (OR among 15-24 year old MSM 28.52 95% CI: 20.69, 39.29; OR among 25 years or

older MSM: 9.45, 95% CI: 7.01, 12.75; 𝛽 p-value = <.0001). Our findings echo earlier research

on the importance of future exploration of patient-provider relationships and stigma regarding

HIV testing among younger MSM. While our study is not generalizable to MSM who did not

take the online survey, our study directly compared younger MSM and older MSM, allowing us

to gain improved insight on factors that may have exacerbated effects on testing among younger

MSM. Future research should continue to compare younger and older MSM to understand the

specific differences in testing associated factors that may impact the success of testing

interventions.

Table of Contents

Background/Literature Review………………………………………..1

Methods……………………………………………………………………. 5

Results……………………………………………………………………... 8

Discussion………………………………………………………………….11

References………………………………………………………………….18

Tables………………………………………………………………………. 21

Appendix…………………………………………………………………...26

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

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 Health Sciences, Epidemiology
Keyword	MSM HIV Testing
Committee Chair / Thesis Advisor	Guest, Jodie, Emory University

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