Abstract
We sought to examine how self-perception of risk for HIV and HIV status information avoidance are related to HIV testing uptake and engagement in routine health care among Black men who have sex with men (BMSM)—the group at highest risk for HIV in the USA. To do so, we used generalized linear modeling and serial mediation modeling to assess data from 342 HIV-negative BMSM collected from 2017 to 2019 in Atlanta, GA, USA. Participants reported considerable concern for testing HIV-positive; 40% reported believing they would test positive for HIV; 27% reported being “extremely concerned about getting HIV”; and 17% reported worrying about HIV “all the time”. Mediation analyses demonstrated that greater concern for HIV was associated with longer intervals since the last HIV test and the last health-care appointment. BMSM perceived themselves to be at considerable risk for HIV, but critically, this outlook did not yield improved health-care behaviors. Findings highlight the need to reconceptualize our public health approach to reaching BMSM. Emphasizing risk behavior and targeting efforts toward BMSM may have unintended consequences and need to be reevaluated. Despite continued efforts to improve HIV-related outcomes, we are failing to meet the needs of BMSM.
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References
Andresen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med, 10, 77-84. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8037935.
Biello, K. B., Edeza, A., Montgomery, M. C., Almonte, A., & Chan, P. A. (2019). Risk perception and interest in HIV pre-exposure prophylaxis among men who have sex with men with rectal gonorrhea and chlamydia infection. Archives of Sexual Behavior, 48, 1185–1190. https://doi.org/10.1007/s10508-018-1260-1.
Boudewyns, V., Paquin, R. S., Uhrig, J. D., Badal, H., August, E., & Stryker, J. E. (2018). An interrupted time series evaluation of the testing makes us stronger HIV campaign for Black gay and bisexual men in the United States. Journal of Health Communication, 23, 865–873. https://doi.org/10.1080/10810730.2018.1528318.
Bowleg, L., Del Rio-Gonzalez, A. M., Holt, S. L., Perez, C., Massie, J. S., Mandell, J. E., & Bone, C. A. (2017). Intersectional epistemologies of ignorance: How behavioral and social science research shapes what we know, think we know, and don’t know about U.S. Black men’s sexualities. Journal of Sex Research, 54, 577–603. https://doi.org/10.1080/00224499.2017.1295300.
Campbell, C. K., Lippman, S. A., Moss, N., & Lightfoot, M. (2018). Strategies to increase HIV testing among MSM: A synthesis of the literature. AIDS and Behavior, 22, 2387–2412. https://doi.org/10.1007/s10461-018-2083-8.
CDC. (2017). Ending the HIV epidemic. https://www.cdc.gov/hiv/. Accessed October 1, 2019.
CDC. (2019a). CDC data confirm: Progress in HIV prevention has stalled. https://www.cdc.gov/media/releases/2019/0227-hiv-prevention-stalled.html Accessed March 19, 2020.
CDC. (2019b). HIV and African American Gay and Bisexual men https://www.cdc.gov/hiv/group/msm/bmsm.html. Accessed September 25, 2019.
CDC. (2020). HIV and African American Gay and Bisexual men. https://www.cdc.gov/hiv/group/msm/bmsm.html Accessed March1, 2020.
Cohen, M. S., Chen, Y. Q., McCauley, M., Gamble, T., Hosseinipour, M. C., Kumarasamy, N., & Team, H. S. (2016). Antiretroviral therapy for the prevention of HIV-1 transmission. The New England Journal of Medicine, 375, 830–839. https://doi.org/10.1056/NEJMoa1600693.
Drumhiller, K., Murray, A., Gaul, Z., Aholou, T. M., Sutton, M. Y., & Nanin, J. (2018). “We deserve better!”: Perceptions of HIV testing campaigns among Black and Latino MSM in New York City. Archives of Sexual Behavior, 47, 289–297. https://doi.org/10.1007/s10508-017-0950-4.
Duncan, D. T., Hickson, D. A., Goedel, W. C., Callander, D., Brooks, B., Chen, Y. T., & Schneider, J. A. (2019). The social context of HIV prevention and care among Black men who have sex with men in three U.S. cities: The neighborhoods and networks (N2) cohort study. International Journal of Environmental Research and Public Health, 16. https://doi.org/10.3390/ijerph16111922.
Egede, L. E., Ellis, C., & Grubaugh, A. L. (2009). The effect of depression on self-care behaviors and quality of care in a national sample of adults with diabetes. General Hospital Psychiatry, 31, 422–427. https://doi.org/10.1016/j.genhosppsych.2009.06.007.
Epstein, S. (1994). Integration of the cognitive and the psychodynamic unconscious. The American Psychologist, 49, 709–724. https://doi.org/10.1037//0003-066x.49.8.709.
Evangeli, M., Pady, K., & Wroe, A. L. (2016). Which psychological factors are related to HIV testing? A quantitative systematic review of global studies. AIDS and Behavior, 20, 880–918. https://doi.org/10.1007/s10461-015-1246-0.
Golub, S. A. (2014). Tensions between the epidemiology and psychology of HIV risk: Implications for pre-exposure prophylaxis. AIDS and Behavior, 18, 1686–1693. https://doi.org/10.1007/s10461-014-0770-7.
Golub, S. A. (2018). PrEP stigma: Implicit and explicit drivers of disparity. Current HIV/AIDS Reports, 15, 190–197. https://doi.org/10.1007/s11904-018-0385-0.
Golub, S. A., & Myers, J. E. (2019). Next-wave HIV pre-exposure prophylaxis implementation for gay and bisexual men. AIDS Patient Care and STDs, 33, 253–261. https://doi.org/10.1089/apc.2018.0290.
Gonzalez, J. S., Batchelder, A. W., Psaros, C., & Safren, S. A. (2011). Depression and HIV/AIDS treatment nonadherence: A review and meta-analysis. Journal of Acquired Immune Deficiency Syndromes, 58, 181–187. https://doi.org/10.1097/QAI.0b013e31822d490a.
Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., & iPrEx Study, T. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. The New England Journal of Medicine, 363, 2587–2599. https://doi.org/10.1056/NEJMoa1011205.
Herbst, J. H., Painter, T. M., Tomlinson, H. L., Alvarez, M. E., Centers for Disease, C., & Prevention. (2014). Evidence-based HIV/STD prevention intervention for black men who have sex with men. MMWR Suppl, 63(1), 21-27. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24743663.
Hess, R. F., & McKinney, D. (2007). Fatalism and HIV/AIDS beliefs in rural Mali, West Africa. Journal of Nursing Scholarship, 39, 113–118. https://doi.org/10.1111/j.1547-5069.2007.00155.x.
Ingersoll, K., Dillingham, R., Reynolds, G., Hettema, J., Freeman, J., Hosseinbor, S., & Winstead-Derlega, C. (2014). Development of a personalized bidirectional text messaging tool for HIV adherence assessment and intervention among substance abusers. Journal of Substance Abuse Treatment, 46, 66–73. https://doi.org/10.1016/j.jsat.2013.08.002.
Janz, N. K., & Becker, M. H. (1984). The health belief model: A decade later. Health Education Quarterly, 11, 1–47. https://doi.org/10.1177/109019818401100101.
Kalichman, S. C., Kelly, J. A., Morgan, M., & Rompa, D. (1997). Fatalism, current life satisfaction, and risk for HIV infection among gay and bisexual men. J Consult Clin Psychol, 65, 542-546. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9256554.
Kingdon, M. J., Storholm, E. D., Halkitis, P. N., Jones, D. C., Moeller, R. W., Siconolfi, D., & Solomon, T. M. (2013). Targeting HIV prevention messaging to a new generation of gay, bisexual, and other young men who have sex with men. Journal of Health Communication, 18, 325–342. https://doi.org/10.1080/10810730.2012.727953.
Macapagal, K., Birkett, M., Janulis, P., Garofalo, R., & Mustanski, B. (2017). HIV prevention fatigue and HIV treatment optimism among young men who have sex with men. AIDS Education and Prevention, 29, 289–301. https://doi.org/10.1521/aeap.2017.29.4.289.
MacKellar, D. A., Valleroy, L. A., Secura, G. M., Behel, S., Bingham, T., Celentano, D. D., & Young Men's Survey Study, G. (2007). Perceptions of lifetime risk and actual risk for acquiring HIV among young men who have sex with men. AIDS and Behavior, 11, 263–270. https://doi.org/10.1007/s10461-006-9136-0.
Mannheimer, S. B., Wang, L., Wilton, L., Van Tieu, H., Del Rio, C., Buchbinder, S., & Mayer, K. H. (2014). Infrequent HIV testing and late HIV diagnosis are common among a cohort of black men who have sex with men in 6 US cities. Journal of Acquired Immune Deficiency Syndromes, 67, 438–445. https://doi.org/10.1097/QAI.0000000000000334.
Mays, V. M., Cochran, S. D., & Zamudio, A. (2004). HIV prevention research: Are we meeting the needs of African American men who have sex with men? Journal of Black Psychology, 30, 78–105. https://doi.org/10.1177/0095798403260265.
Murray, A., Gaul, Z., Sutton, M. Y., & Nanin, J. (2018). “We hide...”: Perceptions of HIV Risk Among Black and Latino MSM in New York City. American Journal of Men's Health, 12, 180–188. https://doi.org/10.1177/1557988317742231.
Myers, J. E., Braunstein, S. L., Xia, Q., Scanlin, K., Edelstein, Z., Harriman, G., & Daskalakis, D. (2018). Redefining prevention and care: A status-neutral approach to HIV. Open Forum Infectious Diseases, 5, ofy097. https://doi.org/10.1093/ofid/ofy097.
Napper, L. E., Fisher, D. G., & Reynolds, G. L. (2012). Development of the perceived risk of HIV scale. AIDS and Behavior, 16, 1075–1083. https://doi.org/10.1007/s10461-011-0003-2.
Noar, S. M., Palmgreen, P., Chabot, M., Dobransky, N., & Zimmerman, R. S. (2009). A 10-year systematic review of HIV/AIDS mass communication campaigns: Have we made progress? Journal of Health Communication, 14, 15–42. https://doi.org/10.1080/10810730802592239.
Olawepo, J. O., Pharr, J. R., & Kachen, A. (2019). The use of social marketing campaigns to increase HIV testing uptake: A systematic review. AIDS Care, 31, 153–162. https://doi.org/10.1080/09540121.2018.1533631.
Price, D. M., Howell, J. L., Gesselman, A. N., Finneran, S., Quinn, D. M., & Eaton, L. A. (2019). Psychological threat avoidance as a barrier to HIV testing in gay/bisexual men. Journal of Behavioral Medicine, 42, 534–544. https://doi.org/10.1007/s10865-018-0003-z.
Reisner, S. L., Mimiaga, M. J., Skeer, M., Bright, D., Cranston, K., Isenberg, D., & Mayer, K. H. (2009). Clinically significant depressive symptoms as a risk factor for HIV infection among black MSM in Massachusetts. AIDS and Behavior, 13, 798–810. https://doi.org/10.1007/s10461-009-9571-9.
Rosenberg, E. S., Millett, G. A., Sullivan, P. S., Del Rio, C., & Curran, J. W. (2014). Understanding the HIV disparities between black and white men who have sex with men in the USA using the HIV care continuum: A modeling study. The Lancet HIV, 1, e112–e118. https://doi.org/10.1016/S2352-3018(14)00011-3.
Rovner, B. W., Haller, J. A., Casten, R. J., Murchison, A. P., & Hark, L. A. (2014). Depression and risk perceptions in older African Americans with diabetes. Diabetes Spectrum: A Publication of the American Diabetes Association, 27, 114–118. https://doi.org/10.2337/diaspect.27.2.114.
Rowniak, S. (2009). Safe sex fatigue, treatment optimism, and serosorting: New challenges to HIV prevention among men who have sex with men. The Journal of the Association of Nurses in AIDS Care, 20, 31–38. https://doi.org/10.1016/j.jana.2008.09.006.
Sileo, K. M., Bogart, L. M., Wagner, G. J., Musoke, W., Naigino, R., Mukasa, B., & Wanyenze, R. K. (2019). HIV fatalism and engagement in transactional sex among Ugandan fisherfolk living with HIV. SAHARA-J: Journal of Social Aspects of HIV/AIDS, 16, 1–9. https://doi.org/10.1080/17290376.2019.1572533.
Stolte, I. G., de Wit, J. B., Kolader, M., Fennema, H., Coutinho, R. A., & Dukers, N. H. (2006). Association between 'safer sex fatigue' and rectal gonorrhea is mediated by unsafe sex with casual partners among HIV-positive homosexual men. Sexually Transmitted Diseases, 33, 201–208. https://doi.org/10.1097/01.olq.0000194596.78637.8e.
Sweeny, K., Melnyk, D., Miller, W., & Shepperd, J. (2010). Information avoidance: Who, what, when, and why. Review of General Psychology, 14, 340–353.
Williams, J. K., Wilton, L., Magnus, M., Wang, L., Wang, J., Dyer, T. P., & Team, H. I. V. P. T. N. S. (2015). Relation of childhood sexual abuse, intimate partner violence, and depression to risk factors for HIV among black men who have sex with men in 6 US cities. American Journal of Public Health, 105, 2473–2481. https://doi.org/10.2105/AJPH.2015.302878.
Yi, H., Sandfort, T. G., & Shidlo, A. (2010). Effects of disengagement coping with HIV risk on unprotected sex among HIV-negative gay men in New York City. Health Psychology, 29, 205–214. https://doi.org/10.1037/a0017786.
Funding
This work was supported by the National Institutes of Health (R01MH109409, R34MH115798, K01DA047918, T32AI102623, and K01DA042881).
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This research involved human subjects and was conducted with the approval of the University of Connecticut Institutional Review Board, and research was conducted in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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Eaton, L.A., Watson, R.J., Maksut, J.L. et al. Elevated Perceived Risk for HIV as a Barrier to Accessing Health Care Among Black Men Who Have Sex with Men. Prev Sci 21, 917–925 (2020). https://doi.org/10.1007/s11121-020-01135-1
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DOI: https://doi.org/10.1007/s11121-020-01135-1