A fifth of gay men
in a relationship with an HIV-negative male partner have not had an HIV test
while in their present relationship, results of US research published in the
online edition of the Journal of Acquired
Immune Deficiency Syndromes show. Factors associated with not having a test
included younger age, lower levels of education, having a sexually “closed”
relationship and greater levels of trust.
urgently needed that not only encourage and assist at-risk HIV-negative
partnered MSM [men who have sex with men] to test for HIV, but to also develop
and sustain an interval testing plan that accurately reflects the dynamics of
their individual risk and relationship profile,” comment the authors.
suggests that between 33 and 66% of HIV infections among gay and bisexual men in
the US are transmitted within the context of a primary relationship. The
Centers for Disease Control and Prevention (CDC) recommend that all sexually
active gay men should have an HIV test at least annually, and more frequent
screening – every three to six months – is recommended for men with known risk
factors for HIV infection, for instance multiple or anonymous sexual partners.
relatively little is known about patterns of HIV testing among gay men in
relationships. Investigators therefore designed a study to ascertain the
frequency of HIV testing among gay men in a relationship with another HIV-negative
man. They also examined the demographic and relationship characteristics
associated with testing.
A total of 275
HIV-negative male couples (550 gay men) were recruited in 2011 via Facebook.
All were aged 18 or over, lived in the US and were in a relationship with
another man and had had oral or anal sex with their primary partner in the
previous three months. Couples where one partner was HIV negative and the other
HIV positive were excluded from the study.
an online questionnaire. They were prompted to describe their HIV testing
history since establishing their current relationship. Demographic data were
also collected, and the men were asked to provide information regarding the
characteristics of their relationship, including duration, the presence of a
sexual agreement (an explicit mutual understanding between the two partners
about permitted sexual behaviour), and also levels of trust, communication and
Almost all the
participants identified as gay, and the majority were white, employed and lived
in an urban environment.
A fifth of men
reported they had not tested for HIV since entering their current
relationship; 30% stated that they tested when they thought they were at risk
of HIV; 29% had an annual HIV test and 21% stated they tested every three to
Compared to the
other testing groups, men who had never tested for HIV were younger (p <
0.000), had a shorter relationship duration (p < 0.000), had lower levels of
education (p < 0.000) and were less likely to have an agreement about the
sexual parameters of their relationship (p < 0.05). Men who had never tested
also reported higher levels of commitment to their relationship (p < 0.05)
and a greater degree of trust and faith in their partner (p < 0.05).
then compared the characteristics of the men who had never tested to those of
participants who reported having an HIV test at least every six months. The
authors found that the men who had tested frequently were more likely to belong
to a racial or ethnic minority (p < 0.05), were more likely to have an
“open” relationship and recently had sex with a man other than their main
partner (p < 0.001) and were also more likely to concur with their partner
about the existence of an agreement that set the permitted sexual parameters of
their relationship (p < 0.05). However, men who tested frequently were less
likely to report trusting their main partner (p < 0.01).
men who never tested and individuals who had an annual HIV screen showed that
the men testing for HIV every twelve months were more likely to have a
bachelors degree or higher (p < 0.05) and to report that they or their
partner had recently had sex outside their relationship (p < 0.01).
Finally, men who
tested when they felt at risk of HIV were more likely than the never tested
group to have a degree (p < 0.01) and to report that they or their partner
had sex outside the relationship (p < 0.05). The at-risk testers also had
significantly lower levels of trust in their partners than the never tested
group (p < 0.05).
believe that an important overall finding of their study was that men who had
greater levels of trust in their partner were more likely to never test for
HIV. They write: “Additional research is warranted to further explore how
concepts of trust affect partnered men’s and gay couples’ HIV testing
behaviours, including their interval or history to test for HIV while in a
They authors believe
that the current CDC testing recommendations for gay men are not specific
enough for those in relationships: “Men who engage in UAI [unprotected anal
intercourse] within their relationship and have sex outside of their
relationship could benefit by getting tested for HIV and STIs more often than
the current recommendation of annually, especially when condoms are not always
used for anal sex with casual partners.”