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1 Who gets tested and where: Patterns of HIV testing among MSM Jennifer L. Lauby, PhD Public Health Management Corporation Philadelphia, PA

2 HIV testing services need to: Find ways to reach and test MSM who have not received services Encourage development of routine patterns of testing Provide information on how often and where to take repeat tests This is particularly important as testing is now being provided in a wide range of settings

3 Research questions to inform HIV testing services Characteristics of men who have not had a recent HIV test Perceived barriers to taking a test Characteristics of men served by different types of testing locations Patterns of testing frequency and repeat visits to the same test location Ways to encourage routine repeat testing

4 Brothers y Hermanos ( ) CDC Cooperative Agreement A collaboration between CDC and four project sites: Public Health Management Corp. Philadelphia recruited 540 Black men NYC Health Dept New York City recruited 614 Black men Educational Development Center New York City recruited 516 Latino men LA Health Dept Los Angeles recruited 563 Latino men

5 Data collection Recruitment using respondent driven sampling (RDS) Eligibility -report sexual contact with a man in the past 12 months ACASI interview on a laptop computer Confirmatory blood test for men who reported being HIV positive Rapid HIV test for all other men

6 Never taken an HIV test 14% of Latino MSM and 9% of Black MSM had never taken a test This difference was not statistically significant after controlling for age and gay identity Of the men who had never tested, 48% of Blacks and 7% of Latinos had a positive result on the study s HIV test

7 Reasons for not testing (could choose more than one answer) FEARS I m afraid I might be HIV + I m afraid my results will be reported to government I m afraid people will think I m gay I m afraid people might treat me differently Blacks (n= 101) 35% 11% 11% 29% Latinos (n=151) 15% 36% 12% 34%

8 Reasons for not testing (could choose more than one answer) LOGISTICS I don t have the time I can t afford it I can t get to the test site I don t know where to get tested Blacks 6% 6% 2% 8% Latinos 13% 16% 4% 9%

9 Reasons for not testing (could choose more than one answer) I M NOT AT RISK I ve been practicing safe sex I know my partners don t have HIV I m not at risk for HIV It s not important Blacks 17% 7% 3% 3% Latinos 28% 18% 13% 2%

10 When was most recent test (among HIV negative men who ever tested, n=1070) 70% 60% 65% 63% 50% 40% 30% 20% 10% 0% past 12 mon 20% 14% 1-2 yrs ago 9% 11% 3-4 yrs ago 6% 4% 5% 2% 5-9 yrs ago 10 or more yrs Black Latino

11 Predictors of testing in past year Black men were 1.5 times as likely as Latino men to have a recent test, controlling for age and gay identity Men under 40 years of age were 2 times as likely as men 40 and over to have a recent test, controlling for race and gay identity

12 Factors Associated with Counseling and Testing (FACT) Study The FACT study was funded by the National Institute of Mental Health to examine barriers to HIV testing Interviews with 451 MSM were conducted in in 65 selected venues in Philadelphia Eligibility - had sexual contact with another man in the past 5 years.

13 Race/Ethnicity of MSM in FACT study (N=420) 80% 60% 40% 20% 0% 28% 23% 42% 6% Black/AA Latino White Asian *Excludes 31 "other" race.

14 HIV testing history 100% 91% 80% 60% 40% 20% 0% 55% Ever tested (N=451) Tested in past 12 months (N=445)

15 Age at first HIV test (n=385) 50% 46% 40% 30% 20% 10% 0% 24% 22% 8% < & over

16 Location of first HIV test (n=385) HIV organization 30% Clinic, hospital or ER 29% Private doctor 23% High risk setting 19% (jail, shelter, D&A treatment)

17 Information received by test location 100% 80% 60% 93% 89% 85% 82% 83% 81% 80% 76% 67% 71% 53% 54% 40% 20% 0% Prevention info Explain results When to test HIV org Clinic Private MD High risk

18 Location of most recent HIV test by location of first test (n=301) FIRST TEST LOCATION HIV Org. Clinic Doctor s Office Highrisk HIV Organization % Clinic or Hospital % Doctor s Office % High-risk Setting %

19 Segmentation analysis of first HIV test location INCOME <20,000 20,000 & OVER RACE Sexual Identity Black & Other Latino & White Gay Non-Gay

20 Location of first HIV test by segments Low Income, Black & Mixed Race (n=78) HIV organization 17% Clinic, hospital or ER 26% Private doctor 14% High risk setting 44% Low Income, Latino & White (n=68) HIV organization 28% Clinic, hospital or ER 38% Private doctor 22% High risk setting 12%

21 Location of first HIV test by segments Moderate Income, Gay (n=194) HIV organization 38% Clinic, hospital or ER 24% Private doctor 29% High risk setting 10% Moderate Income, Bisexual & Straight (n=45) HIV organization 24% Clinic, hospital or ER 40% Private doctor 11% High risk setting 24%

22 Limitations of this analysis Was limited to men recruited in Philadelphia Data were collected 7 to 8 years ago Rapid testing was not available at the time of the survey Recall bias because men were reporting on their first test, which could have occurred several years previously

23 Conclusions 10 to 15% of MSM of color have never had an HIV test. Fear of being positive and fear of disclosure are main barriers to testing. About half of MSM of color have not had a test in the past 12 months. Latino men and men 40 years and over are less likely to have had a recent test.

24 Conclusions Location of testing is important to consider because it affects the type and amount of information provided. MSM tend to get subsequent tests in the same type of location as their first test. Location of HIV testing varies by income, race and sexual identity.

25 Areas for further research on HIV testing among MSM Evaluate a range of recruitment strategies for HIV testing, including social networks, outreach, providing testing in hospitals and unconventional locations Examine characteristics of MSM recruited by these different strategies and locations Assess patterns of testing, including frequency and location of testing, among segments of the MSM population Evaluate strategies for encouraging repeat testing