Voluntary HIV testing: Factors associated with repeated HIV testing among a sample of HIV-negative gay and bisexual men living in Toronto, Canada

Background:

Routine HIV testing remains the sole method to detect HIV infection early and initiate treatment. Though testing is available at no cost in Canada, uptake is not optimal. We explored factors associated with voluntary (not work/immigration mandated) number of times HIV testing was accessed over the past nine months in a sample of gay and bisexual men (GBM) in Toronto.

Method:

Data from 470 HIV-negative GBM from three time points (baseline, 3-month and 6-month follow-up) were used. Considering personal, psychosocial (depression, openness, sexual self-esteem, childhood trauma) and sexual behaviors (number of  partners, condomless anal sex, substance use before/during sex) as separate blocks, negative binomial models with a sandwich estimator estimated relative contributions of each factor, as well as in factor blocks. The final model included significant (p<0.10) factors from three primary models.

Results:

Most participants (mean age=35;SD=12) were White(59%), born in Canada(60%), and self-identified as gay(86%). Approximately 9% reported never testing, 58% once, 24% twice and 10% three times in the past 9 months. In the final model, older age, being single, childhood trauma, and higher sexual self-esteem predicted increased HIV testing. Engagement in sexual risk was not associated with greater HIV testing.  

Conclusions:

Our results highlight the importance of considering relationship status and potential for couples-based testing for promotion of HIV testing services with GBM. Since engagement in sexual risk was not associated with increased utilization of HIV testing services, renewed focus into what does and does not constitute HIV-related sexual risk behavior should be considered for GBM.