"I'm trying to live a real total life": Black MSM negotiating HIV testing practices amidst conflicting social contexts

Background: Black men who have sex with men (MSM) have some of the highest HIV/AIDS rates in the United States. Public health officials are encouraging increased testing initiatives among members of this population, yet qualitative descriptions of social considerations influencing their testing practices and experiences are lacking. Methods: We conducted semi-structured one-on-one interviews with 28 self-identified Black MSM in Atlanta, Georgia, exploring several domains relating to HIV testing practices and experiences. Results: Four participants self-disclosed as HIV-positive (14%) and 24 as HIV negative/unknown (86%). Of those who reported being HIV negative/unknown, 100% reported testing in the past year. Sixty-one percent (17/28) reported that their last HIV test was at a doctor's office or clinic, while the remaining 39% (11/28) reported other locations, including community-based organizations, schools and churches. Common themes included: 1) weighing social pros and cons of testing at specific locations; 2) perceived risky sexual behavior and “routine check-up” as primary motivators of testing; 3) importance of HIV testing as routine health care maintenance; and 4) quality of HIV testing experiences depending on professionalism and experience of personnel. Conclusions: Contrary to previous studies, this sample of Black MSM reported recent HIV testing practices. While doctors' offices were the most commonly mentioned HIV testing setting, quality of testing staff appeared to be the most important variable factoring into positive testing experiences. Future research and interventions addressing HIV testing among Black MSM should emphasize quality of testing personnel and other social considerations instead of merely access considerations.