Facilitators and barriers associated with HIV testing among heterosexual African American men in rural Florida, 2011

Background:  In the United States, African American (AA) men are disproportionately affected by human immunodeficiency virus (HIV), especially in the rural south where HIV increasingly affects persons exposed through heterosexual activity. HIV testing and treatment for some AA men at traditional health care facilities remains a challenge and interventions are lacking.  We explored facilitators and barriers associated with HIV testing among heterosexual AA men in rural Florida.

Methods: We conducted 12 focus group interviews with HIV-uninfected AA men who participated in an HIV testing randomized controlled trial, were from two rural counties and one semi-rural county in north Florida, and self-identified as heterosexual.  Using computer-assisted thematic analyses, we examined transcribed focus group responses for main themes.

Results: Sixty-seven men participated (median age = 41.5 years; range 18-64 years); 62% (n=42) earned a monthly income of < $500, 10% (n=7) attained education beyond high school, 55% (n=37) were married, and 60% (n=40) reported practicing monogamy. Main themes regarding facilitators of HIV testing included: 1) using preferred HIV testing community locations (park, library, gym); 2) providing incentives (food or money); and 3) peer-led messaging for free, rapid HIV testing.  Themes for barriers included: 1) HIV testing at the local health department; and 2) social and emotional consequences, including stigma, fear, and rejection by family and friends.

Conclusion: Effective HIV testing interventions for heterosexual AA men in rural areas likely need to incorporate suggested facilitators (including preferred locations, incentives and messaging) and reduce perceived barriers in order to improve HIV testing efforts.