HIV testing patterns among black men who have sex with men: a qualitative typology.
BACKGROUND
Black men who have sex with men (MSM) in the Southeastern United States are disproportionately affected by HIV. Black MSM are more likely to have unrecognized HIV infection, suggesting that testing may occur later and/or infrequently relative to current recommendations. The objective of this qualitative study was to explore the HIV testing behaviors of Black MSM in Atlanta, Georgia, who were participants in the HIV Prevention Trials Network Brothers Study (HPTN 061).


RESULTS
We conducted 29 in-depth interviews and four focus groups with a community-recruited sample. Modified grounded theory methodologies were used to guide our inductive analysis, which yielded a typology comprised of four distinct HIV testing patterns. Participants could be categorized as: (1) Maintenance Testers, who tested regularly as part of routine self-care; (2) Risk-Based Testers, whose testing depended on relationship status or sexual behavior; (3) Convenience Testers, who tested irregularly depending on what testing opportunities arose; or (4) Test Avoiders, who tested infrequently and/or failed to follow up on results. We further characterized these groups with respect to age, socioeconomic factors, identity, stigma and healthcare access.


CONCLUSIONS
Our findings highlight the heterogeneity of HIV testing patterns among Black MSM, and offer a framework for conceptualizing HIV testing in this group. Public health messaging must account for the diversity of Black MSM's experiences, and multiple testing approaches should be developed and utilized to maximize outreach to different types of testers.
Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia, United States of America ; Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America.
Sophia A
SA
Hussen
Robert
R
Stephenson
Carlos
C
del Rio
Leo
L
Wilton
Jermel
J
Wallace
Darrell
D
Wheeler
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D006679:HIV Seropositivity; D006297:Health Services Accessibility; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012307:Risk Factors; D012725:Sexual Behavior; D012747:Sexual Partners; D014481:United States / Q000453:epidemiology; D055815:Young Adult