July 9, 2019

African-American men who have sex with men (MSM) and have never been tested for HIV are a small group, but they have a significant impact on the HIV epidemic. New research from a faculty member at the UNC Gillings School of Global Public Health shows that efforts to end this epidemic must address the different needs of men who have been historically underserved by HIV prevention and treatment efforts.

Dr. Derrick Matthews

Dr. Derrick Matthews

Derrick Matthews, PhD, assistant professor in the Department of Health Behavior at the Gillings School, is lead author of “Black Men Who Have Sex with Men and Lifetime HIV Testing: Characterizing the Reasons and Consequences of Having Never Tested for HIV,” which was published online May 14 in Prevention Science.

Matthews and his team used data from Promoting Our Worth, Equality and Resilience (POWER), a cross-sectional observational study that recruited African-American MSM at Black Pride events across six cities in the United States from 2014 to 2017. Participants completed an anonymous questionnaire and were offered free, confidential HIV testing. POWER’s model is significant for its ability to reach a substantial number of African-American MSM at various Pride events, identify those who’d never received an HIV test before and provide on-site testing in the moment.

Of the 4,174 participants without a prior HIV diagnosis, nearly one in 10 had never been tested for HIV. Results showed these men had multiple factors associated with never having been tested, including lower education, greater internalized homophobia, fear of results, lack of health coverage and depressive symptoms. Of the participants who received their first HIV test through the POWER study, about one-third ended up having an HIV-positive test result.

“Though it is a minority of Black MSM who have never been tested for HIV, this group can have a disproportionately large influence on the HIV epidemic if they do become HIV-positive,” said Matthews. “This is due to both their unaddressed individual health needs and their capacity to unknowingly infect others.”

There is no singular effective way to approach HIV testing for Black MSM, says Matthews. Among those who guessed they were HIV-negative, the most common reason for not getting tested was a belief that they were at low risk for HIV infection. Among those who guessed they were HIV-positive, the most common reason for avoiding testing was being afraid of the test results confirming they were HIV-positive.

“In this study, Black MSM who had avoided testing because they feared the results were three times as likely to be infected. In these cases, an acute awareness of heightened risk may have inhibited testing instead of facilitating it,” said Matthews.

The U.S. Preventive Services Task Force recommends that clinicians routinely screen all adolescents and adults for HIV as a part of routine care. Making HIV testing a more standardized part of health care could help reduce the stigma around HIV, while reducing the number of people who are unaware of their HIV status.

In a country where African-American MSM have a one-in-two lifetime risk of becoming HIV-positive, efforts to truly end the HIV epidemic will require drastic investments in addressing the health inequities in HIV that Black MSM experience, says Matthews. Therefore, addressing the needs of this relatively small group is vital.

“These health inequities are not acceptable. They are, nevertheless, accepted — because HIV impacts the most marginalized groups in our society,” said Matthews. “Ending the HIV epidemic in this country will require an explicit focus on, centering of and leadership by those have been most underserved in HIV prevention and treatment efforts to date.”

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