A fifth of gay men in a relationship with an HIV-negative man have not tested for HIV while in their current relationship

Higher levels of trust associated with not testing

Michael Carter
Published: 26 August 2013

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.

“Interventions are 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.

Previous research 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.

However, 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.

Participants completed 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 commitment.

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 six months.

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).

The investigators 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).

Comparison between 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).

The investigators 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 primary relationship.”

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.”


Mitchell JW et al. Factors associated with regular HIV testing among a sample of US MSM with HIV-negative main partners. J Acquir Immune Defic Syndr, online edition. DOI: 10.1097/QAI.0b013e318a6c8d9, 2013.

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