Patterns of HIV testing practices among young gay and bisexual men living in Scotland: a qualitative study

Abstract

BackgroundIncreasing overall rates, and frequency, of HIV testing in populations at risk is a key public health objective and a critical dimension of HIV prevention efforts. In the UK, men who have sex with men (MSM) remain one of the communities most at risk of HIV and, within this, young gay men are a key risk group. Understanding HIV testing practices is important in the development of interventions to promote testing among young gay and bisexual men.MethodsQualitative interviews were conducted with thirty young gay and bisexual men (aged 18–29) in Scotland. Thematic analysis of men’s accounts of their approach to HIV testing identified three overarching patterns of testing: ‘habitual’, ‘reactive’ and ‘ ad hoc’.ResultsThis qualitative study, the first to explore patterns of HIV testing practices among young gay and bisexual men in the UK, contributes novel findings around the role of social support and ‘community’ in shaping young men’s approaches to HIV testing. The findings suggest that social support can play an important role in encouraging and facilitating HIV testing among young gay men, however, social norms of non-testing also have the potential to act as a barrier to development of a regular routine. Men with habitual testing practices framed HIV testing as both a personal and ‘community’ responsibility, and more effective than testing in response to risk events or emergent symptoms. Men who reported reactive testing practices described testing for HIV primarily in response to perceived exposure to sexual risk, along with ‘transitional moments’ such as starting, ending or changes to a relationship. Among young men who reported testing on an ad hoc basis, inconvenience and disruptions to HIV testing practices, particularly where men lacked social support, acted as a barrier to developing a routine of regular testing.ConclusionsOur findings suggest that interventions which seek to increase rates of HIV testing and testing frequency among young gay and bisexual men should include a specific focus on promoting and supporting positive testing practices within young men’s friendship groups and wider gay communities.

Factors Affecting HIV Testing among Youth in Kenya

“…However, they stress that many pathways of social support have not yet been explored in HIV intervention studies. Other studies also suggest social support is important for HIV testing and that low levels of social support may serve as a barrier to testing among numerous populations of men who have sex with men (MSM) in the United Kingdom and United States [18,19]. Social support also has been found to be an important factor in disclosing one’s status to others.…”

Thematic synthesis HIV prevention qualitative studies in men who have sex with men (MSM)

“…The results are presented at two different times: the first is a demonstration of the general characteristics of the 48 selected studies and the second is the compilation of the most relevant and recurring themes of the analyzed production. Of the 48 selected studies for this synthesis, 24 (50%) were conducted in North America (mainly the United States) , eight (16.7%) in Thematic synthesis HIV prevention qualitative studies in men who have sex with men (MSM) Europe [44][45][46][47][48][49][50][51] , five (10.4%) in Africa [52][53][54][55][56] , four (8.3%) in Oceania [57][58][59][60] , four (8.3%) in South and Central America [61][62][63][64] and three (6.2%) in Asia [65][66][67] (Table 2).…”

“…Of the 48 studies previously mentioned, 38 dealt exclusively with the population of MSM without HIV, and of these, eight studies included ethnic markers 25,29,33,38,40,42,43,52 and three of them included generational markers 26,45,48 . Four other studies included populations of MSM and HIV-positive people within the dynamics of serodiscordant relationships.…”

“…Thirteen studies addressed the HIV test strategy, one of which appears along with the TP strategy 67 and another with the condom 56 . Also notable is the number of studies involving diagnostic tests in the last five years, five of them published in 2017 22,43,45,50,63 .…”

Developing a Typology of HIV/STI Testing Patterns Among Gay, Bisexual, and Queer Men: A Framework to Guide Interventions

“…Several typologies relating to HIV testing behaviors have been proposed in the extant literature. Boydell, Buston, and McDaid (2017) propose three patterns of HIV testing among young gay and bisexual men in Scotland, including habitual testers who test as a personal or community responsibility, reactive testers who test in response to exposure to sexual risk or to new relationships, and ad hoc testers who are motivated to test but experience barriers or disruptions to regular testing schedules. Similarly, Hussen and colleagues (2013) propose a typology of four testing patterns among Black men who have sex with men (MSM) in southeastern United States, namely, maintenance testers who test regularly as a responsibility to self, risk-based testers who test as a result of sexual behavior or new relationships, convenience testers who test as and when opportunities arise, and test avoiders who test irregularly or do not follow up on results.…”