title: Infrequent HIV testing and late HIV diagnosis are common among a cohort of black men who have sex with men in 6 US cities.
abstract: OBJECTIVE
  US guidelines recommend at least annual HIV testing for those at risk. This analysis assessed frequency and correlates of infrequent HIV testing and late diagnosis among black men who have sex with men (BMSM).
  
  
  METHODS
  HIV testing history was collected at enrollment from participants in HPTN 061, an HIV prevention trial for at-risk US BMSM. Two definitions of late HIV diagnosis were assessed: CD4 cell count <200 cells per cubic millimeter or <350 cells per cubic millimeter at diagnosis.
  
  
  RESULTS
  HPTN 061 enrolled 1553 BMSM. HIV testing questions were completed at enrollment by 1284 (98.7%) of 1301 participants with no previous HIV diagnosis; 272 (21.2%) reported no HIV test in previous 12 months (infrequent testing); 155 of whom (12.1% of the 1284 with testing data) reported never testing. Infrequent HIV testing was associated with: not seeing a medical provider in the previous 6 months (relative risk [RR]: 1.08, 95% confidence interval [CI]: 1.03 to 1.13), being unemployed (RR: 1.04, CI: 1.01 to 1.07), and having high internalized HIV stigma (RR: 1.03, CI: 1.0 to 1.05). New HIV diagnoses were more likely among infrequent testers compared with men tested in the previous year (18.4% vs. 4.4%; odds ratio: 4.8, 95% CI: 3.2 to 7.4). Among men with newly diagnosed HIV, 33 (39.3%) had a CD4 cell count <350 cells per cubic millimeter including 17 (20.2%) with CD4 <200 cells per cubic millimeter.
  
  
  CONCLUSIONS
  Infrequent HIV testing, undiagnosed infection, and late diagnosis were common among BMSM in this study. New HIV diagnoses were more common among infrequent testers, underscoring the need for additional HIV testing and prevention efforts among US BMSM.
authors.affiliation: *Department of Medicine, Harlem Hospital/Columbia University, New York, NY; †Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; ‡Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; §Department of Human Development, College of Community and Public Affairs, Binghamton University, Binghamton, NY; ‖Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa; ¶Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY; #Department of Global Health, Center for AIDS Research, Emory University Rollins School of Public Health, Atlanta, GA; **Bridge HIV, Population Health Division, San Francisco Department of Public Health, San Francisco, CA; ††College of Nursing and Health Sciences, Florida International University, Miami, FL; ‡‡Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, DC; §§Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; and ‖‖Infectious Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, The Fenway Institute, Boston, MA.
authors.forename: Sharon B
authors.initials: SB
authors.lastname: Mannheimer
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.forename: Leo
authors.initials: L
authors.lastname: Wilton
authors.forename: Hong
authors.initials: H
authors.lastname: Van Tieu
authors.forename: Carlos
authors.initials: C
authors.lastname: Del Rio
authors.forename: Susan
authors.initials: S
authors.lastname: Buchbinder
authors.forename: Sheldon
authors.initials: S
authors.lastname: Fields
authors.forename: Sara
authors.initials: S
authors.lastname: Glick
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Connor
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cummings
authors.forename: Susan H
authors.initials: SH
authors.lastname: Eshleman
authors.forename: Beryl
authors.initials: B
authors.lastname: Koblin
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult