Personal and Contextual Factors Related to Delayed HIV Diagnosis Among Men Who Have Sex With Men

Abstract

Delayed HIV diagnosis among men who have sex with men (MSM) in the United States continues to be a significant personal and public health issue. Using qualitative and quantitative data from 75 recently tested, HIV-seropositive MSM (38 delayed and 37 non-delayed testers) we sought to further elucidate potential personal and contextual factors that may contribute to delayed HIV diagnosis among MSM. Our findings indicate MSM who experience multiple life stressors, whether personal or contextual, have an increased likelihood of delaying HIV diagnosis. Further, MSM experiencing multiple life stressors without the scaffolding of social support, stable mental health, and self-efficacy to engage in protective health behaviors may be particularly vulnerable to delaying diagnosis. Interventions targeting these factors as well as structural interventions targeting physiological and safety concerns are needed to help MSM handle their life stressors more effectively and seek HIV testing in a timelier manner.

HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading?

“…As with HIV incidence, data suggest an even higher burden of late diagnoses among racial/ethnic minority MSM secondary to HIV stigma and limited social support. [98][99][100] Breaking chains of HIV transmission necessitates not just coverage of HIV testing, but the diagnosis of people during the acute and early infection stages followed by effective and sustained intervention. Thus, universal HIV treatment approaches are challenged in terms of optimising clinical outcomes and eliminating onward HIV transmission in the context of late diagnoses.…”

HIV Testing Behavior and Social Network Characteristics and Functions Among Young Men Who have Sex with Men (YMSM) in Metropolitan Detroit

“…The following demographic factors have been associated with HIV testing behavior among MSM: older age, [6, 9–18]; education level [16, 19, 20]; and socio-economic status (SES) [11, 16, 21]. MSM’s high-risk sexual behavior has also been found to be either negatively associated with timely HIV testing [11, 15, 20, 22], or to be unassociated with it [10, 12, 23].…”

“…Seeking sexual partners on the Internet has been negatively associated with HIV testing among MSM [19, 20]. As for psychosocial factors, perceptions of risk have been positively associated with HIV testing [6, 15, 18, 23, 24], as has self-efficacy to engage in protective behaviors [21]. More use of information regarding HIV/AIDS has also been associated with greater HIV testing intentions among YMSM [25].…”

“…Social support has indeed been associated with HIV testing in the US [11, 17, 21, 53, 54] and internationally [16, 55]. Additionally, HIV-related stigma is characterized by social distancing [56] from people who are HIV-positive (or perceived to be HIV-positive); indeed, several studies have found a significant, negative association between social support and both perceived and enacted stigma among people with HIV/AIDS [57–59].…”

Social networks and social support among ball-attending African American men who have sex with men and transgender women are associated with HIV-related outcomes

“…Participants who, out of necessity, availed themselves of $40 or a place to stay from their social support alters may be experiencing a level of chaos in their lives that makes it difficult to access testing on a regular basis. Consistent with this idea, a recent study found that experiencing a greater number of life stressors, such as homelessness, was associated with delayed HIV testing among a sample of men who have sex with men (Nelson et al, 2014). Coping with chronic daily stressors and hassles may decrease motivation or ability to get tested every six months.…”