Motivational Factors That Influence HIV Testing in Gay and Bisexual Men: Implications for Future Message Development

Theoretical Background and research questions/hypothesis: Gay, bisexual, and other men who have sex with men (MSM), continue to be disproportionately affected by HIV in the United States. Among MSM, there are also significant racial/ethnic disparities in HIV incidence, with black and Hispanic/Latino MSM carrying a disproportionate burden. A primary strategy to combat new HIV infections is to maximize the number of people who are aware of their HIV infection and foster earlier diagnosis and linkages to appropriate care, treatment, and prevention services. This study had two goals: (1) segment black, Hispanic/Latino, and white MSM based on their HIV-testing intentions and behaviors to identify what percentage of the population would most benefit from a motivational- or skills-based intervention, and whether this differs by race/ethnicity; and (2) use the Integrative Model to determine the extent to which norms, attitudes, and self-efficacy explain HIV-testing intentions in this sample of MSM.

Methods: Secondary analysis of data collected from an anonymous, Web-based survey of sexually active, HIV negative/unknown status MSM was conducted (n=2,485). The survey assessed demographic characteristics, psychosocial factors, HIV-prevention behaviors, and HIV testing, among other variables. Bivariate associations between race/ethnicity and sample characteristics, and theoretical variables were examined. Hierarchical linear regression analysis was conducted to assess correlates of intentions to get tested for HIV in the next 6 months. In Step 1, the background variables were entered to account for factors referred to as “external variables” in the Integrative Model. Background variables included age, proxies for financial or environmental constraints, potential risk factors, and HIV-testing knowledge. In Step 2, the variables from the Integrative Model were added to the regression equation.

Results: There was a significant association between racial/ethnic group and the intention-behavior segments: black and Hispanic/Latino MSM were more likely to have been tested in the past 6 months and intend to get tested in the next 6 months than white MSM. Overall, nearly a third of all respondents intended to get tested in the next 6 months, but hadn’t been tested in the past 6 months, suggesting there may be structural barriers to testing that diminish the relationship between behavioral intent and behavior. Across the three groups of MSM, injunctive norms, descriptive norms related to sexual partners, and behavioral beliefs were significantly associated with intentions for HIV testing. Among black MSM, increased confidence in their ability to get tested was a significant predictor. For both black and Hispanic/Latino MSM, increased knowledge about recommended testing intervals significantly predicted intentions. Some potential barriers identified were lack of insurance (white men), concerns about confidentiality of test results (white men), inability to find a provider they trust (black men), and access to fewer testing sites in a 10-mile radius (Hispanic/Latino men).

Conclusions: Race/ethnicity was significantly associated with intention-behavior segment. Constructs from the Integrative Model were significantly correlated with HIV-testing intention, although significant constructs varied by race/ethnicity.

Implications for research and/or practice: Theoretical constructs that motivate MSM to undergo HIV testing are not uniform across racial/ethnic groups. Findings offer insight into future targeted messaging for HIV testing among MSM of different backgrounds.