HIV testing interventions should challenge fears of a positive result

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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 recently.

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, 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.



Studies aim to give information that will be applicable to a large group of people (e.g. adults with diagnosed HIV in the UK). Because it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn’t a problem as long as the characteristics of the sample are similar to those of the wider group (e.g. in terms of age, gender, CD4 count and years since diagnosis).


Confounding exists if the true association between one factor (Factor A) and an outcome is obscured because there is a second factor (Factor B) which is associated with both Factor A and the outcome. Confounding is often a problem in observational studies when the characteristics of people in one group differ from the characteristics of people in another group. When confounding factors are known they can be measured and controlled for (see ‘multivariable analysis’), but some confounding factors are likely to be unknown or unmeasured. This can lead to biased results. Confounding is not usually a problem in randomised controlled trials. 

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 once.

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 testing behaviours.

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 non-testers.

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 be entrenched.

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.


Knussen C et al. Factors associated with recency of HIV testing amongst men residing in Scotland who have sex with men. AIDS Care 26: 297-303, 2014.