title: Barriers to HIV testing and characteristics associated with never testing among gay and bisexual men attending sexual health clinics in Sydney.
abstract: BACKGROUND
  HIV diagnoses among gay and bisexual men have increased over the past decade in Australia. HIV point-of-care testing (POCT) was introduced in Australia in 2011 as a strategy to increase HIV testing by making the testing process more convenient. We surveyed gay and bisexual men undergoing POCT to assess barriers to HIV testing and characteristics associated with not having previously tested for HIV (never testing).
  
  
  METHODS
  During 2011 and 2012, gay and bisexual men who were undergoing POCT at four Sydney sexual health clinics self-completed questionnaires assessing testing history and psychological and structural barriers to HIV testing. Bivariate and multivariate logistic regression was used to assess associations between patient characteristics and never testing.
  
  
  RESULTS
  Of 1093 participants, 981 (89.9%) reported ever testing for HIV and 110 (10.1%) never testing. At least one barrier to testing was reported by 1046 men (95.7%), with only 47 men (4.3%) not reporting any barrier to testing. The most commonly reported barriers to testing were annoyance at having to return for results (30.2%), not having done anything risky (29.6%), stress in waiting for results (28.4%), being afraid of testing positive (27.5%) and having tested recently (23.2%). Never testing was independently associated with being non-gay-identified (adjusted odds ratio [AOR]: 1.9; 95% confidence interval [CI]: 1.1-3.2), being aged less than 25 years (AOR: 2.4; 95% CI: 1.6-3.8), living in a suburb with few gay couples (AOR: 1.9; 95% CI: 1.2-3.0), being afraid of testing HIV-positive (AOR: 1.6; 95% CI: 1.0-2.4), not knowing where to test (AOR: 3.8; 95% CI: 1.3-11.2) and reporting one or no sexual partners in the last six months (AOR: 2.7; 95% CI: 1.2-6.2).
  
  
  CONCLUSIONS
  Barriers to HIV testing were commonly reported among the clinic-based gay and bisexual men in this study. Our findings suggest further health promotion and prevention strategies are needed to address the knowledge, attitudes and behavioural factors associated with never testing.
authors: The Kirby Institute, UNSW Australia, Sydney, Australia.|Short Street Sexual Health Centre, St George Hospital, Sydney, Australia; dconway@kirby.unsw.edu.au.
authors: Damian P
authors: DP
authors: Conway
authors: Centre for Social Research in Health, UNSW Australia, Sydney, Australia.
authors: Martin
authors: M
authors: Holt
authors: Western Sydney Sexual Health Centre, Western Sydney Local Health District, Sydney, Australia.|The Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.
authors: Deborah L
authors: DL
authors: Couldwell
authors: Albion Centre, Sydney, Australia.|School of Public Health and Community Medicine, UNSW Australia, Sydney, Australia.
authors: Don E
authors: DE
authors: Smith
authors: North Shore Sexual Health Service, Royal North Shore Hospital, Sydney, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors: Stephen C
authors: SC
authors: Davies
authors: School of Public Health and Community Medicine, UNSW Australia, Sydney, Australia.|Sydney Sexual Health Centre, Sydney Hospital, Sydney, Australia.
authors: Anna
authors: A
authors: McNulty
authors: The Kirby Institute, UNSW Australia, Sydney, Australia.
authors: Phillip
authors: P
authors: Keen
authors: St Vincent's Centre for Applied Medical Research, UNSW Australia, Sydney, Australia.|NSW State Reference Laboratory for HIV, St Vincent's Hospital, Sydney, Australia.
authors: Philip
authors: P
authors: Cunningham
authors: The Kirby Institute, UNSW Australia, Sydney, Australia.
authors: Rebecca
authors: R
authors: Guy
mesh_terms: D000328:Adult; D001315:Australia; D001727:Bisexuality; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D060728:Reproductive Health
keywords: barriers to HIV testing; gay and bisexual men; never testing; sexual health clinics