November 12, 2008

November 12, 2008
Why are gay men reluctant to test for HIV?

Welcome to another look into my life. I hope you are having a great week so far.

One problem that I have run into since about 2000 is that gay men are not getting tested for HIV. In the past eight years, I have probably talked to close to 5000 gay men in several cities and almost 1/3 of them had not been for a HIV test in more than a year.

So why is that I pondered?

Gay and bisexual men who have not recently tested for HIV often believe that they have not taken enough risks to justify a test or that the psychological impact of a positive diagnosis would be too great. Personally, I think health promotion interventions which would help men reassess their own thinking about HIV tests.

A recent study recruited 297 men at gay bars. To take part, men had to have sex with men, not have been tested for HIV in the last four years, and never received a positive diagnosis.

Very few of the participants had a strong intention to get tested in the next few months. They tended to be well connected to the gay community, and two fifths had had unprotected anal intercourse with more than one partner in the last year.

Participants completed a questionnaire. For one set of questions, they were asked to imagine that someone had suggested they take an HIV test within the next ten days, and to identify what thoughts the suggestion would prompt in them. A list of possible thoughts was provided, although participants were able to add in other thoughts. It is notable that only negative thoughts were suggested and ideas relating to the benefits of testing were not included.

Participants reported an average of eight thoughts each. The two most common thoughts, suggested by at least two thirds of the group, were:

* ĒI donít really need a test, because I havenít taken any/many risks, so Iím pretty sure I havenít got HIVĒ.

* ĒI donít really need a test, because I havenít had any symptoms that might suggest Iíve got HIVĒ.

The researchers then used a statistical technique (Principal Factor Analysis) which analized the correlations between the different thoughts in order to put them into groups (factors). Five factors emerged.

The first, and most important factor, grouped together a number of perceived long term problems associated with having HIV. The most important was: ďIf I find out Iíve got HIV, that might wreck my relationship with my boyfriend/partner. Itís better not to find outĒ.

Another thought in this factor noted that the boyfriend may realize that his partner had not been monogamous. Several other thoughts included the phrase ďitís better not to find outĒ and mentioned changes to oneís sex life, being set apart from friends, depression and stress.

The second factor grouped together concerns about the confidentiality of the HIV test. The most important statement in this group was: ďI donít want to be listed on some file as having HIV. Iím not sure the test result would remain private.Ē A similarly worded statement about being listed as having gone for testing also scored highly.

The third factor appears to link together thoughts about short term problems associated with the test, including dislike of needles and not having enough time.

The fourth factor brought together thoughts which suggest that HIV testing is unnecessary. One thought suggested that the respondent had not taken many risks, another that HIV was uncommon in the respondentís social circle, and another that the respondent had no symptoms of HIV infection.

The last factor that was significant enough to remain in the analysis included one statement only. It was: ďThereís no great urgency about having the test. Iíll have it eventually I guess, but thereís no rush.Ē

Those men who had had unprotected anal intercourse with more than one man in the last year tended to report a higher number of thoughts (average 11) than men who had taken fewer sexual risks. This group also had higher rates of testing than the rest of the sample, which the researchers believe means that they had some awareness of their level of risk.

Nonetheless, like all others in the survey, these men had not tested in the last four years, and their behavior could mean that they had more reason to fear a positive result. The researchers suggest that many of the thoughts of these men are in fact rationalizations, and that the greater risk produced a need to seize on any plausible means of explaining the decision not to test.

In analyzing these findings, the researches suggest that while more factual information about testing and changes to testing procedures could encourage a few men to test more often, it would not change many peopleís behavior.

They note the Prospect Theory which is used by psychologists. It states that prospective gains and losses are not weighed equally. Instead, the losses loom larger than the gains, which leads us to prefer to postpone a decision or to leave a situation unchanged.

The researchers suggest that it may be possible to design interventions which would help men to understand that their thoughts are in fact rationalizations. In psychology, a rationalization is a deference mechanism by which your true motivation is concealed by explaining your actions and feelings in a way that is not threatening.

A possible intervention would involve presenting men with a list of justifications for not being tested, asking them to say which ones figure in their own thinking, and then asking them to carefully evaluate the adequacy of each one.

The authors also suggest that rather than trying in vain to get men to see the benefits of testing, health promoters can also focus on losses. However they should try to change the type of losses that men focus on and not the disadvantages of testing, but the disadvantages of not having tested early enough.

Health promoters could, for example, get gay men to imagine a time in the future when, not having been tested, they discover that they were infected quite some time previously, and are now unable to reap the full benefits of early treatment. The authors state that focusing on anticipated regret in this way has been found to be a powerful motivator of other types of health protective behavior.

So to wrap it up, no matter what your sexual orientation if you are having sex with someone (even if you think you are in a monogamous relationship); GET TESTED!

Wishing you health, hope and happiness.

big bear hug,

Daddy Dab