Predictors of HIV Testing among Rural Gay and Bisexual Men

Background: HIV testing is an important tool for addressing the HIV epidemic. Social engagement, outness, and experiences with violence have been identified as predictors of HIV test-seeking in metropolitan US populations. In rural contexts, further research is needed to describe the determinants of HIV test-seeking behavior.

Methods:  An online cross-sectional survey was administered to 422 gay and bisexual men in a predominantly rural midwestern state. The survey included measures of demographic characteristics, outness, self-acceptance and self-reported experiences with mental illness, social engagement, violence, and HIV-testing. Logistic regression was employed to examine associations of these variables with testing. 

Results: In a type 3 adjusted analysis, social engagement and outness were found to be significant independent predictors of HIV testing. Self-acceptance and perceptions of targeted violence were not found to be significant independent predictors of HIV testing. Social engagement was associated with 157.6% greater odds of HIV-testing (95% CI [56.4, 324.1], p = .0002) and high degrees of outness were associated with 83.8% greater odds of HIV-testing (95% CI: [6.9, 216.0], p = .0278). Self-acceptance and being a perceived target of violence were not found to be significantly associated with HIV testing (p = .755 and p = .237 respectively).

Conclusions:  Addressing stigma, discrimination, and providing safe social spaces and activities to increase social engagement and outness may be key to maintaining and increasing HIV test rates among gay and bisexual male populations living in predominantly rural areas in the US.