Getting Comfortable while Getting Tested: YMSM's Reflections on HIV/STI testing sites in Southeast Michigan

Background: Regular HIV/STI testing among young men who have sex with men (YMSM) ages 15-24 continues to be an important HIV/STI prevention strategy (CDC, 2013); however, researchers have documented that YMSM experience widespread discrimination within medical settings due to a lack of lesbian, bisexual, gay, transgender, and queer (LGBTQ) cultural competency. It is imperative that we explore what helps YMSM feel a sense of comfort in testing situations.

Methods: Using a “secret shopper” methodology, we conducted an evaluation of 47 HIV/STI testing sites across Southeast Michigan. Each site was visited twice by a racially diverse, gay-identified YMSM (N=5) between the ages of 22 and 31. Participants recorded a total of 97 observations over four months, providing written reflections about their experiences within the site environment, as well as their interactions with HIV/STI staff and providers. We used open coding and thematic analysis to identify the overarching domains that shaped participants’ sense of comfort during testing sessions.

Results: Among the salient domains related to establishing comfort were staff demeanor, sex positivity, LGBTQ friendliness, and issues surrounding confidentiality/privacy. Evaluators described a spectrum of experiences, from egregious errors by test counselors to rewarding and affirming interactions.   The diversity of testing accounts, both positive and negative, challenged the assumption of LGBTQ sensitivity in HIV/STI testing sites. 

Conclusions: Based on our analyses, we underscore the need for LGBTQ cultural sensitivity across the testing process and discuss strategies to improve YMSM’s HIV/STI initiatives. Such initiatives may help safeguard YMSM from potentially harmful experiences while seeking care.