Ecological barriers to HIV testing among black heterosexual men and black men who have sex with men in chicago: Improving HIV testing for a vulnerable population

Background: Black heterosexual men (BHM) and Black men who have sex with men (BMSM) are at high risk for HIV and suboptimal HIV testing. Up to 48% of HIV positive Black men do not know their status, resulting in excess morbidity and transmission. We conducted a qualitative study to yield an explanatory description of perceived barriers to HIV testing in BHM and BMSM. Methods: Self-identified BHM and BMSM (ages 18-49, mean = 31) were recruited using convenience sampling at a public health clinic and venues serving BMSM in Chicago. Forty-eight non-HIV infected men completed 70-minute focus groups of approximately 8 men. The ecological framework was used to analyze responses to open-ended questions targeting psychological, social/ interpersonal, and structural barriers to HIV testing. Three reviewers independently coded the transcripts thematically without disagreement. Results: Over 90% of participants had obtained at least 1 HIV test in the past, but most tested inconsistently. Shared barriers included: lack of health insurance, low health literacy, and physician mistrust. BMSM felt that testing was stigmatizing for presumed sexual orientation and promiscuity. BMSM perceived that HIV testing in public health clinics and community events was conducted by BMSM from their social network and risked confidentiality breaches. Young BMSM conceptualized HIV as non-life threatening, which deprioritized testing. Conclusions: Psychological, social/interpersonal, and structural barriers limit HIV testing amongst BHM and BMSM. For BMSM, future efforts should focus on reducing stigma from HIV testing, addressing the potential confidentiality breaches, and educating young men about health threats still associated with HIV/AIDS.