While HIV testing has been named a crucial component in the Centers for Disease Control and Prevention (CDC)'s strategy for many years, a new meta-analysis shows that black men who have sex with men (BMSM) in the U.S. tend to receive at least one HIV test in a lifetime but have not gotten tested frequently or recently. This study was published in the Journal of Acquired Immune Deficiency Syndrome.
"To the best of our knowledge, this is the first comprehensive meta-analysis of HIV testing patterns among BMSM in the United States," the authors write. The researchers did a review of peer-reviewed papers on HIV testing and black gay and bisexual men published between January 1996 and April 2018. The final analysis was conducted on 67 studies, which included 42,074 men. They sorted testing patterns into three categories: lifetime, recent, and frequent. Lifetime was defined as whether a person had ever been tested for HIV. A recent test was in the past 6, 12, or 24 months before study participation. Finally, the frequent HIV testing definition used the CDC recommendation for gay men of every three to six months.
The researchers did find some good news. Lifetime HIV testing prevalence was high, at 88%. Yet the percentage of black gay and bisexual men who had an HIV test in the six months before the study was 63%, and the percentage of frequent testers dropped to only 42%.
When digging deeper into the socio-demographics of black gay and bisexual men in those studies, the researchers found that men who reported having condomless anal sex -- receptive and/or insertive -- had higher lifetime and past-12-months testing prevalence than others, suggesting that potentially men who were willing to self-report their sexual behavior were more likely to also seek testing more regularly. Socioeconomic status and age also appeared to influence testing patterns. Low annual income (earning less than $20,000/year), history of homelessness, and a lack of health insurance were associated with a lower likelihood of having lifetime and past-12-months HIV testing among BMSM.
The authors note that while they looked at a large sample of studies, they saw the number of studies in recent years dwindle, which seems strange, given the dramatic changes in HIV prevention and care that have occurred over that period of time. Pre-exposure prophylaxis (PrEP), an emphasis on viral suppression, and even same-day-start antiretroviral therapy have all become the gold standard, which begins with increasing HIV testing. And yet there are fewer studies to understand black gay and bisexual men and their testing patterns, needs, or desires.
"First, we found surprisingly few studies published in 2014 and after that targeted BMSM to specifically assess HIV testing, highlighting an urgent need of conducting up-to-date research of HIV testing among BMSM," the authors note.
Second, the authors write that more than half of the included studies were secondary data analyses from a larger clinical trial or survey, such as the National HIV Behavioral Surveillance Study. Third, the instruments for assessing HIV testing patterns are limited in assessing recent or repeat (frequency) testing.
They also note that of the studies they analyzed, more of them focused on young black gay and bisexual men, and "no study purposefully sampled middle-aged or older BMSM … who are suggested to be more likely to have late-stage HIV infection at the time of diagnosis." They also noticed most studies were conducted in large metropolitan cities on the coasts, while few focused on small or mid-sized cities, particularly in the South, "where HIV epidemics among MSM of color are surging."
The study's results are similar to a 2017 systematic review among 83,186 MSM using websites and mobile apps, which found that approximately 85% had ever been tested and 58% had gotten tested in the preceding year.