Gay Americans unaware of the potential health benefits of taking HAART are less likely to seek HIV testing, according to a study published in the October 2002 edition of the Journal of Acquired Immune Deficiency Syndromes.
Investigators from the US Centers for Disease Control conducted face-to-face interviews, as part of the HIV Testing Survey with people at higher risk of HIV in eight US states in 1995-96 and again in 1998-99. Three high-risk groups were identified: gay men; injecting drug users; and, heterosexuals attending sexual health clinics. Gay men were recruited at gay bars; drug users via street outreach; and heterosexuals at clinics.
At the study interview, participants were asked to provide background demographic information. In addition, they were asked to say if they had had a previous HIV test and to say why they were currently seeking an HIV test. Participants were also asked if they agreed or disagreed with statements designed to assess attitudes and beliefs about HIV.
1,599 people were recruited to the 1995-96 study and the 1998-99 sample included 1,711, with the samples equally divided between the at-risk populations.
Slightly more people reported a previous HIV test in 1998-99 (80%) than in the earlier study (77%). In both samples, people under 25 were significantly less likely to report an earlier HIV test.
The overwhelming reason identified for HIV testing was knowledge, “to know where you stood”, with 90% of participants providing this answer in both surveys. A fear that they had been exposed to HIV was expressed by 60% of participants in 1995-96 and 58% in 1998-99.
When investigators examined the responses from people who had never tested for HIV, they found that in both samples, denial of a risk of HIV was the main reason (17% in the first sample, and 30% in 1998-99), or an assumption that they were HIV-negative (14%, pre-HAART, 22%, post-HAART).
Investigators noted that untested gay men in both samples were particularly likely to deny that they had been at risk of HIV (52% first study, and 60% in the follow-up).
However, fear of HIV fell between 1996 and 1999. In 1995-96, 27% of people who said they hadn’t had an HIV test, said it was through fear of receiving a positive result, but this had fallen to 18% by the time of the second survey. Although not asked directly about HAART, a knowledge that treatments can reduce illness and prolong life in people with HIV was indicated by the study participants. In the pre-HAART survey, nearly a third of non-testers agreed with a statement that “there is little you can do if you test positive for HIV”. This had fallen by over a half to 14% by 1998-99.
Gay men testing for HIV were found to be significantly more likely than their untested peers in both studies to be aware of the potential benefits of HIV treatments. In both samples, 83% of gay men testing agreed that, “medical care can help sick HIV-positive persons remain healthier.” In 1995-96 only 66% of those untested agreed with this and despite HAART, this figure fell to 57% in the later study. In addition, approximately 85% of tested gay men and 66% of untested gay men in both surveys agreed with the statement “medical care can help HIV-positive persons stay well if they are not currently sick.”
The investigators conclude that their findings suggest that HIV prevention and testing messages should continue to be targeted at specific groups and particularly gay men.
However, a major weakness of this study, not acknowledged by the investigators, was a failure to ask study participants what type of risk behaviour they had been engaged in. This can make a huge difference to perceptions of HIV risk. For example, a gay man who only has oral sex is likely to consider himself to be of much lower risk of HIV, and consequently less likely to seek testing, than a gay man who has frequent unprotected anal sex with casual partners.
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Kellerman SE et al. HIV testing within at-risk populations in the United States and the reasons for seeking and avoiding HIV testing. Journal of Acquired Immune Deficiency Syndromes 31: 202-210, 2002.