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HIV, STI Testing Rates Too Low in Southeast Michigan


New study findings show suboptimal HIV and sexually transmitted infection (STI) testing rates among sexual and gender minority individuals in the state, contrary to CDC guidelines.

More than a third of adolescents and young adults (AYAs) in southeastern Michigan who used or misued substances and were in a sexual or gender minority group had not been tested for HIV or sexually transmitted infections (STIs) in the last year.

Additionally, less than half of AYAs met the CDC testing recommendations.

These findings were published in JMIR Public Health and Surveillance, where the authors noted that transgender individuals and men who have sex with men are at an increased risk of HIV and other STIs compared with cisgender heterosexual individuals. Substance use increases this risk, warranting research to understand existing testing behaviors.

The study authors used data on 414 sexual and gender minority AYAs aged 15 to 29 years living in southeastern Michigan who self-reported using substances. These data were pulled from results of a baseline survey for the Swerve trial, a 4-arm randomized controlled trial analyzing the efficacy of a brief substance use intervention in improving HIV prevention.

Using multinomial logistic regression models, the authors looked at self-reported HIV and STI testing patterns in an individual’s lifetime and the past 12 months. They also compared testing behaviors across demographic and HIV-related characteristics, psychosocial barriers, substance use, and sexual behaviors.

The CDC recommends all sexually active sexual and gender minority individuals, who are young and use substances, be tested for STIs annually and for HIV every 3 to 6 months. The authors found that 35.5% of AYAs had not been tested for HIV or STIs in the previous year and 40.6% followed the CDC testing recommendations.

Regarding demographic characteristics, older AYAs were more likely to have been tested for HIV and STIs in their lifetime and in the last 12 months compared with those who were younger. Additionally, AYAs who identified as cisgender were 77% more likely to receive both HIV and STI testing in their lifetime than to only receive STI testing, but were 5 times more likely to have only received HIV testing in the past 12 months.

The authors also found that participants who identified as gay were more likely to get tested for HIV and STIs, while participants who identified as bisexual were more likely to only test for STIs.

Another major finding was that tobacco use and hazardous drinking—determined using the Alcohol Use Disorders Identification Test—were not associated with either lifetime or 12-month testing rates. However, sedative and opioid use were associated with lifetime HIV and STI testing, and use of cannabis, opioids, or amyl nitrite were all associated with 12-month HIV and STI testing.

Although there are several limitations in the study, especially surrounding sample size, the authors noted the need for improvements in HIV and STI testing among sexual and gender minority AYAs.

“To meet the CDC’s guidelines on testing, HIV and STI testing interventions need to recognize the specific barriers to engaging in testing experienced by substance-using sexual and gender minority AYAs who experience multiple layers of potential stigma grounded in their age, sexual, and gender identities, and substance use behavior,” the authors concluded. “Central to this is the recognition that not all substances are linked to testing behaviors in the same way, and research and programmatic efforts need to consider the differential testing needs, attitudes, and barriers of different types of substance-using AYAs.”

Parker JN, Choi SK, Bauermeister JA, Bonar EE, Carrico AW, Stephenson R. HIV and sexually transmitted infection testing among substance-using sexual and gender minority adolescents and young adults: baseline survey of a randomized controlled trial. JMIR Public Health Surveill. Published online July 1, 2022. doi:10.2196/30944

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