title: Regular STI testing amongst men who have sex with men and use social media is suboptimal - a cross-sectional study.
abstract: Sexually transmitted infections (STIs) disproportionately affect men who have sex with men, with marked increases in most STIs in recent years. These are likely underpinned by coterminous increases in behavioural risks which have coincided with the development of Internet and geospatial sociosexual networking. Current guidelines advocate regular, annual sexually transmitted infection testing amongst sexually active men who have sex with men (MSM), as opposed to symptom-driven testing. This paper explores sexually transmitted infection testing regularity amongst MSM who use social and sociosexual media. Data were collected from 2668 men in Scotland, Wales, Northern Ireland and the Republic of Ireland, recruited via social and gay sociosexual media. Only one-third of participants report regular (yearly or more frequent) STI testing, despite relatively high levels of male sex partners, condomless anal intercourse and high-risk unprotected anal intercourse. The following variables were associated with regular STI testing; being more 'out' (adjusted odds ratio = 1.79; confidence interval = 1.20-2.68), HIV-positive (adjusted odds ratio = 14.11; confidence interval = 7.03-28.32); reporting ≥10 male sex partners (adjusted odds ratio = 2.15; confidence interval = 1.47-3.14) or regular HIV testing (adjusted odds ratio = 48.44; confidence interval = 28.27-83.01). Men reporting long-term sickness absence from work/carers (adjusted odds ratio = 0.03; confidence interval = 0.00-0.48) and men aged ≤25 years (adjusted odds ratio = 0.36; 95% confidence interval = 0.19-0.69) were less likely to test regularly for STIs. As such, we identify a complex interplay of social, health and behavioural factors that each contribute to men's STI testing behaviours. In concert, these data suggest that the syndemics placing men at elevated risk may also mitigate against access to testing and prevention services. Moreover, successful reduction of STI transmission amongst MSM will necessitate a comprehensive range of approaches which address these multiple interrelated factors that underpin MSM's STI testing.
authors.affiliation: 1 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow.
authors.forename: Jamie
authors.initials: J
authors.lastname: Frankis
authors.affiliation: 2 Cobridge Sexual Health Centre, Church Terrace, Cobridge, Stoke on Trent.
authors.forename: Lisa
authors.initials: L
authors.lastname: Goodall
authors.affiliation: 3 Chalmers Sexual Health Centre, NHS Lothian, Edinburgh.
authors.forename: Dan
authors.initials: D
authors.lastname: Clutterbuck
authors.affiliation: 4 School of Health and Life Sciences, GCU London, Glasgow Caledonian University, Glasgow.
authors.forename: Abdul-Razak
authors.initials: AR
authors.lastname: Abubakari
authors.affiliation: 1 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow.
authors.forename: Paul
authors.initials: P
authors.lastname: Flowers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D018451:Homosexuality, Male; D006801:Humans; D007494:Ireland; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009660:Northern Ireland; D010342:Patient Acceptance of Health Care; D012606:Scotland; D012749:Sexually Transmitted Diseases / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D014852:Wales; D055815:Young Adult
keywords: Europe; Men who have sex with men; UK; homosexual; men; screening; sexual behaviour; sexually transmitted infection testing; social media