Possible Link Found Between Recent HIV Results, Testing-Related Behavior

June 3, 2020

There was a 6% increase from 2005 to 2014 in new HIV diagnoses among gay, bisexual, and other men who have sex with men, according to the CDC and study results published in Journal of Epidemiology and Community Health, and 1 in 6 is estimated to test positive for the disease at some point in his lifetime.

Are there behaviors and demographics that distinguish those who have recently been tested for HIV, results notwithstanding, from those who have not? According to study results published in Journal of Epidemiology and Community Health, yes, and they help to shape outreach efforts to those at risk of contracting HIV.

“In order to locate HIV testing where it is needed most, it is important to examine the ways in which someone at risk for HIV who has recently tested for HIV might differ from someone who has not,” the authors noted. “HIV testing represents a pivotal moment in individualized health care.”

Data were gathered for investigation in the Together 5000 study of cisgender and transgender men and transgender women, and participants were identified via ads for free at-home HIV testing that appeared in men-for-men geosocial networking apps. They were enrolled between October 2017 and June 2018 and had an average age of 31 years.

Most identified as cisgender male, close to half were persons of color, and a majority had some college experience.

Potential enrollees completed an initial survey, which collected demographic information, including on sexual behavior and substance use. That determined their eligibility for the study, after which they received a link to a second survey. Part of this latter survey included sending in a saliva sample collected via an OraSure HIV-1 Oral Specimen Collection device, which was used to determine their HIV status.

The primary outcomes in this study were 2-fold:

  • Within-group differences of negative or positive HIV test results
  • Prior test for HIV in the year leading up to study enrollment

Study participants were divided into 4 groups, based on HIV status at enrollment and self-reported prior-year test results, respectively:

  1. Negative/negative (n = 3070)
  2. Negative/no HIV test (n = 1739)
  3. Positive/negative (n = 68)
  4. Positive/no HIV test (n = 124)

Study results indicated that 192 (3.8%) participants received a positive test at study enrollment, but only 68 (35.4%) had been tested for HIV in the previous year, with negative results. This indicated that their infection was recent. In addition, of the 96% (n = 4809) who received a negative test at enrollment, 36.1% had not been tested in the previous year.

Most who tested positive were persons of color, while a majority of the negative group were white. The positive group also had a great likelihood of never having used pre- or postexposure prophylaxis, as well as difficulties related to housing instability in the previous 5 years, racial/income disparities, and exchanging money for sex in the past 3 months.

The positive group was also more likely to have used methamphetamine in the past 3 months. Close to 40% had used the addictive stimulant, compared with less than 10% of HIV-negative enrollees.

“This finding highlights the ongoing need to address what has been termed the ‘double epidemic’ whereby methamphetamine use is integrally connected to risk for HIV,” the authors noted.

Regardless of HIV test results at enrollment, however, being tested in the previous year compared with not being tested was associated with a greater likelihood of having a primary care provider: 56% vs 47%.

There is room for improvement in testing for HIV and reaching out to those deemed to be most at risk, and the authors suggest addressing social determinants of health and personal behaviors that can have a negative affect on patient outcomes, including housing, health care access, exchanging money for sex, and using methamphetamine.

“Our findings highlight that strategies aimed at increasing HIV testing among this group might be well served to holistically and synergistically address broader needs of this population,” they concluded. “And although it is beyond the scope of the present study, these findings also highlight the need to investigate interpersonal and psychological barriers that may prevent someone from seeking HIV testing, such as perceived stigma and avoidance behaviors.”

Reference

Grov C, Westmoreland D, Golub SA, Nash D. Prior HIV testing behaviour is associated with HIV testing results among men, trans women and trans men who have sex with men in the United States. J Epidemiol Community Health. Published online May 20, 2020. doi: 10.1136/jech-2019-213493