Among gay and bisexual men in Glasgow, not having recently
taken an HIV test is associated with being under the age of 25, over the age of
45, a fear of receiving an HIV-positive result and not perceiving HIV testing
to be typical amongst gay friends. Interventions to promote HIV testing should
address these issues, researchers suggest in the March issue of AIDS Care.
Their study also found that men who had unprotected
anal sex were more likely than others to have tested, but that men with
particularly risky sexual behaviour (e.g. unprotected sex with multiple
partners of unknown HIV status) were not especially likely to have tested
They conducted a cross-sectional survey in seven gay bars and
clubs in Glasgow in July 2010, with the questions on testing answered by 683
men who did not have diagnosed HIV. As previously
reported on aidsmap.com, a comparison of surveys conducted in the years 2000
and 2010 suggested that the proportion of gay men testing for HIV in the
previous year increased from 27 to 57% over the ten-year period.
For the current analysis, the researchers focused on the
demographic, behavioural and attitudinal factors that were associated with HIV
testing in the 2010 survey.
Respondents’ average age was 32, half used gay commercial
venues at least once a week and half had had anal sex with at least two
partners in the previous year.
Overall, 57.2% had tested for HIV in the previous year,
22.7% had tested more than a year ago and 20.1% had never tested.
HIV testing behaviour differed significantly according to
age. On average, those tested over a year ago were older than other
respondents, while those under the age of 25 were likely to have either
tested within the previous year or not at all.
On the other hand, different levels of education, or the frequency with
which men used the gay scene, were not associated with HIV testing.
Those who had tested within the past year were more likely
than other respondents to have had two or more sexual partners in the past
year. They were also more likely to have had unprotected anal sex at least
But amongst those who had had unprotected sex, additional
risk factors made no difference to how recently men had tested. In other words,
men who had had unprotected sex with multiple partners, casual partners, men of
unknown HIV status or men known to have HIV were no more likely to have tested
in the past year than men who had had unprotected anal sex with one man.
The researchers asked a number of questions about beliefs
and attitudes in order to see if these influenced testing behaviour.
Most men could see the potential advantages of HIV testing –
including men who had never tested. After controlling for confounding factors,
beliefs about testing benefits did not distinguish testers from non-testers.
Similarly, perceived problems with clinic procedures (delays
in getting results, staff attitudes, etc.) were not associated with different
Moreover, negative attitudes to sex with HIV-positive
partners (e.g. “I wouldn't have anal sex with anyone I knew was HIV positive”)
were quite widely shared, and did not clearly differentiate testers from
However, men who had a greater fear of receiving a positive
result were somewhat less likely to have tested recently, or at all, than other
men. Attitudes around fear were tested by asking respondents to agree or
disagree with statements such as “I do not want to test because of the
psychological consequences of a positive result” or “I would rather get ill
than find out I was HIV positive”.
Moreover, men who disagreed with the statement “Most of my
gay friends have had an HIV test” were somewhat less likely to have tested
recently than other men.
The authors say that their results highlight a need to
promote HIV testing, with interventions for those whose sexual behaviour puts
them at risk, especially men under 25 and over 45 years of age. Different
approaches are likely to be needed for the different age groups – convincing
the older men is likely to be more challenging, as attitudes are more likely to
The results showing few associations between sexual and HIV
testing behaviours suggest that “the perception of risk within the sample – or
the role it played in triggering an HIV test – was limited”.
Interventions should promote a positive norm for testing and
challenge fear of a positive test result, the authors say.