Barriers to HIV testing and characteristics associated with never testing among gay and bisexual men attending sexual health clinics in Sydney

Damian P Conway; Martin Holt; Deborah L Couldwell; Don E Smith; Stephen C Davies; Anna McNulty; Phillip Keen; Philip Cunningham; Rebecca Guy; Sydney Rapid HIV Test Study

doi:10.7448/IAS.18.1.20221

Barriers to HIV testing and characteristics associated with never testing among gay and bisexual men attending sexual health clinics in Sydney

J Int AIDS Soc. 2015 Aug 27;18(1):20221. doi: 10.7448/IAS.18.1.20221. eCollection 2015.

Authors

Damian P Conway^{1

2}, Martin Holt³, Deborah L Couldwell^{4

5}, Don E Smith^{6

7}, Stephen C Davies^{8

9}, Anna McNulty^{7

10}, Phillip Keen¹, Philip Cunningham^{11

12}, Rebecca Guy¹; Sydney Rapid HIV Test Study

Affiliations

¹ The Kirby Institute, UNSW Australia, Sydney, Australia.
² Short Street Sexual Health Centre, St George Hospital, Sydney, Australia; dconway@kirby.unsw.edu.au.
³ Centre for Social Research in Health, UNSW Australia, Sydney, Australia.
⁴ Western Sydney Sexual Health Centre, Western Sydney Local Health District, Sydney, Australia.
⁵ The Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.
⁶ Albion Centre, Sydney, Australia.
⁷ School of Public Health and Community Medicine, UNSW Australia, Sydney, Australia.
⁸ North Shore Sexual Health Service, Royal North Shore Hospital, Sydney, Australia.
⁹ Sydney Medical School, University of Sydney, Sydney, Australia.
¹⁰ Sydney Sexual Health Centre, Sydney Hospital, Sydney, Australia.
¹¹ St Vincent's Centre for Applied Medical Research, UNSW Australia, Sydney, Australia.
¹² NSW State Reference Laboratory for HIV, St Vincent's Hospital, Sydney, Australia.

Abstract

Introduction: HIV diagnoses among gay and bisexual men have increased over the past decade in Australia. HIV point-of-care testing (POCT) was introduced in Australia in 2011 as a strategy to increase HIV testing by making the testing process more convenient. We surveyed gay and bisexual men undergoing POCT to assess barriers to HIV testing and characteristics associated with not having previously tested for HIV (never testing).

Methods: During 2011 and 2012, gay and bisexual men who were undergoing POCT at four Sydney sexual health clinics self-completed questionnaires assessing testing history and psychological and structural barriers to HIV testing. Bivariate and multivariate logistic regression was used to assess associations between patient characteristics and never testing.

Results: Of 1093 participants, 981 (89.9%) reported ever testing for HIV and 110 (10.1%) never testing. At least one barrier to testing was reported by 1046 men (95.7%), with only 47 men (4.3%) not reporting any barrier to testing. The most commonly reported barriers to testing were annoyance at having to return for results (30.2%), not having done anything risky (29.6%), stress in waiting for results (28.4%), being afraid of testing positive (27.5%) and having tested recently (23.2%). Never testing was independently associated with being non-gay-identified (adjusted odds ratio [AOR]: 1.9; 95% confidence interval [CI]: 1.1-3.2), being aged less than 25 years (AOR: 2.4; 95% CI: 1.6-3.8), living in a suburb with few gay couples (AOR: 1.9; 95% CI: 1.2-3.0), being afraid of testing HIV-positive (AOR: 1.6; 95% CI: 1.0-2.4), not knowing where to test (AOR: 3.8; 95% CI: 1.3-11.2) and reporting one or no sexual partners in the last six months (AOR: 2.7; 95% CI: 1.2-6.2).

Conclusions: Barriers to HIV testing were commonly reported among the clinic-based gay and bisexual men in this study. Our findings suggest further health promotion and prevention strategies are needed to address the knowledge, attitudes and behavioural factors associated with never testing.

Keywords: barriers to HIV testing; gay and bisexual men; never testing; sexual health clinics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Australia
Bisexuality*
HIV Infections / diagnosis*
HIV Infections / prevention & control
Homosexuality, Male / psychology*
Humans
Logistic Models
Male
Middle Aged
Point-of-Care Systems
Reproductive Health