HIV testing among U.S. men: How does sexual orientation matter?

Background: HIV testing is important for preventing the spread of HIV. However, non-heterosexual men's high HIV prevalences warrant examinations of the ways sexual orientation predicts testing behaviors. Studies mostly examine HIV testing without adjusting for sociodemographic and risk factors that differ among bisexual, heterosexual, and homosexual men. Most use single sexual orientation measures, which reveal little regarding the independent effects of sexual behavior, identity, and attraction. This study examined multiple sexual orientation measures' relationships with HIV testing among U.S. men. Methods: Data came from the National Survey of Family Growth. HIV testing measures assessed previous testing and the reasons for the men's tests. Logistic regression modeled all sexual orientation indicators as predictors of ever testing, past-year testing, and testing to know one's HIV status. Multivariate analyses controlled for sociodemographic and risk confounders. Results: Homosexually-active men had substantially greater likelihoods of testing (ever and during the past year) and testing solely to discover their HIV serostatuses than all other men, even when adjusting for sociodemographic and risk covariates. Bisexual behavior-identity interaction revealed that bisexually-active men identifying as bisexual had the lowest likelihoods of testing. But bisexually-active men had significantly more sex partners, drug use, and sex work than other men. Sexual attraction did not significantly predict HIV testing. Conclusions: Homosexual activity independently increased men's likelihoods for HIV testing. Bisexually-active men, in light of their substantially high levels of risk, had surprisingly low levels of testing. The author advocates for evidence-based interventions to increase bisexually-active men's inclinations to test for HIV.