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Despite recommendations of annual HIV testing for high-risk individuals, one-third of infected men who have sex with men (MSM) are unaware of their serostatus. In an effort to improve HIV prevention services and subsequently decrease prevalence, this study aimed to examine the HIV testing patterns and factors associated with testing frequency among MSM. Utilizing eight reliable and validated instruments and a sample of 374 sexually active MSM, this study examined a series of demographic, behavioral and psychosocial associations of antibody testing frequency, including substance use/abuse, depression levels, internalized homophobia, unprotected anal intercourse, sexual regulation and attribution, and HIV knowledge, . MSM who tested for HIV frequently were more likely to be older, have higher levels of educational attainment, and self-identify as gay. Respondents who reported never having been tested and irregularly tested had higher levels of internalized homophobia, depression, and alcohol use and abuse patterns. Respondents who had never been tested or infrequently tested engaged in lower levels of sexual risk, particularly unprotected receptive anal intercourse. Those with no or irregular histories of testing also exhibited greater external sexual loci of control, and were significantly more likely to attribute life events to external, unstable, and pessimistic causes.
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2. Hall HI, An Q, Tang T, Song R, Chen M, Green T, Kang J. Prevalence of diagnosed and undiagnosed HIV infection – United States, 2008-2012. MMWR Morb Mortal Wkly Rep. 2015;64(24):657-662.
3. Skarbinski J, Rosenberg E, Paz-Bailey G, Hall HI, Rose CE, Viall AH, Fagan JL, Lansky A, Mermin, J.H. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588-596. doi: 10.1001/ jamainternmed.2014.8180
4. Centers for Disease Control and Prevention. HIV infection risk, prevention, and testing behaviors among men who have sex with men – National HIV behavioral surveillance, 20 U.S. cities, 2014. Centers for Disease Control and Prevention. https://www.cdc.gov/ hiv/pdf/ library/reports/surveillance/cdc-hiv-surveillance-special-report-number-15.pdf. Published January, 2016. Accessed December 23, 2020.
5. Emory University Rollins School of Public Health. Local data: Atlanta. AIDSVu. https://aidsvu.org/local-data/united-states/south/georgia/atlanta/. Accessed December 23, 2020.
6. Goodreau SM, Rosenberg ES, Jenness SM, Luisi N, Stansfield SE, Millett GA, Sullivan PS. Sources of racial disparities in HIV prevalence in men who have sex with men in Atlanta, GA, USA: A modelling study. Lancet HIV. 2017;4(7):E311-E320. doi: 10.1016/ S2352- 3018(17) 30067-X
7. Georgia Department of Public Health. Georgia Integrated HIV Care and Prevention Plan. Georgia HIV Surveillance Data. https://dph.georgia.gov/epidemiology/ georgias-hivaids-epidemiology-section/georgia-hiv-surveillance-data. Published September 23, 2020. Accessed December 23, 2020.
8. World Health Organization. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations, 2016 update. https://www.who.int/hiv/pub/ guidelines/ keypopulations-2016/en/. Published July, 2016. Accessed January 19, 2021.
9. Cheng W, Egan JE, Liu Q, Xu H, Stall R, Friedman MR. Psychosocial correlates of HIV testing frequency among men who have sex with men in Guangzhou, China. AIDS Behav. 2020;24:363-372. doi: 10.1007/s10461-019-02431-w
10. UNAIDS. 90-90-90: An ambitious treatment target to help end the AIDS epidemic. UNAIDS; 2014.
11. McDaid LM, Hart GJ. Increased HIV testing and reduced undiagnosed infection among gay men in Scotland, 2005-8: Support for the opt-out testing policy? Sex Transm Infect. 2011;87 (3):221-224. doi: 10.1136/sti.2010.044560
12. Centers for Disease Control and Prevention. HIV testing and risk behaviors among gay, bisexual, and other men who have sex with men – United States. MMWR Morb Mortal Wkly Rep. 2013;62(47):958-962.
13. Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191-215.
14. Bandura A. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall; 1986.
15. Bandura A. Social cognitive theory. In: Vasta R, ed. Annals of child development. Greenwich, CT: Jai Press; 1989;1-60.
16. Safren SA, Traeger L, Skeer M, O’Cleirigh C, Meade CS, Covahey C, Mayer KH. Testing a social-cognitive model of HIV transmission risk behaviors in HIV-infected MSM with and without depression. Health Psychol. 2010;29(2):215-221. doi: 10.1037/ a0017859
17. Li X, Zhang L, Mao R, Zhao Q, Stanton B. Effect of social cognitive theory-based HIV education prevention program among high school students in Nanjing, China. Health Educ Res. 2011;26(3):419-431. doi: 10.1093/her/cyr001
18. Puljic VM, Licina MLK, Javic M, Blazic TN. Repeat HIV testing at voluntary testing and counseling centers in Croatia: Successful HIV prevention or failure to modify risk behaviors? PLoS One. 2014;9(4):e93734. doi: 10.1371/journal.pone.0093734
19. Sabato TM, Burnett AJ, Kerr DL, Wagner L. Examining behavioral and psychosocial predictors of antibody testing among college youth: Implications for HIV prevention education and testing. Am J Sex Educ. 2013;8(1-2):56-72. doi: 10.1080/15546128. 2012.740893
20. Chesney M, Folkman S, Chambers D. Coping effectiveness training for men living with HIV: Preliminary findings. Int J STD AIDS. 1996;7(2):75-82.
21. Carey MP, Schroder KE. Development and psychometric evaluation of the brief HIV knowledge questionnaire (HIV-KQ-18). AIDS Educ Prev. 2002;14:174-184.
22. Pando MAM, Balan I, Marone R, Dolezal C, Barreda V, Carballo Dieguez A, Avila MM. HIV knowledge and beliefs among men who have sex with men (MSM) in Buenos Aires, Argentina. AIDS Behav. 2013;17(4):1305-1312.
23. Pokorny AD, Miller BA, Kaplan HB. The Brief Michigan Alcoholism Screening Test. Am J Psychiatry. 1972;129:342-354.
24. Skinner HA. Drug Use Questionnaire: DAST-20. Addiction Research Foundation; 1982.
25. DeCamp W, Bakken NW. Self-injury, suicide ideation, and sexual orientation: Differences in in causes and correlates among high school students. J Inj Violence Res. 2016;8(1):15-24.
26. Radloff LS. The CES-D Scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385-401.
27. Rubenstein LM, Freed RD, Shapero BG, Fauber RL, Alloy LB. Cognitive attributions in depression: Bridging the gap between research and clinical practice. J Psychother Integr. 2016;26(2):103-115. doi: 10.1037/int0000030
28. Shapcott KM., Carron AV. Development and validation of a team attributional style questionnaire. Group Dyn. 2010;14(2):93-113. doi: 10.1037/a0018252
29. Fresco DM, Alloy LB, Reilly-Harrington N. Association of attribution style for negative and positive events and the occurrence of life events with depression and anxiety. J Soc Clin Psychol. 2006;25(10):1140-1160.
30. Peterson C, Park N, Pole N, D’Andrea W, Seligman ME. Strengths of character and posttraumatic growth. J Trauma Stress Disord Treat. 2008;21(2):214-217. doi: 10.1002/ jts.20332
31. Peterson C, Semmel A, von Bayer C, Abramson LY, Metalsky GI, Seligman ME. The attributional style questionnaire. Cognit Ther Res. 1982;6:287-299.
32. Kleim B, Gonzalo D, Ehlers A. The Depressive Attributions Questionnaire (DAQ): Development of a short self-report measure of depressogenic attributions. J Psychopathol Behav Assess. 2011;33:375-385. doi: 10.1007/s10862-011-9234-9
33. Dixon D, Saul J, Peters M. Psychosocial correlates of HIV sexual protective behavior among Puerto Rican women residing in the Bronx, New York. Health Care Women Int. 2010;31(3):274-293. doi: 10.1080/07399330903171416
34. Gwandure C, Mayekiso T. Predicting HIV risk using a loc of control-based model among university students. J Child Adolesc Ment Health. 2010;22(2):119-129. doi: 10.2989/ 17580583.2010.528579
35. Catania JA, McDermott LJ, Wood JA. Assessment of locus of control: Situational specificity in the sexual context. J Sex Res. 1984;20:310-324.
36. Segrin C, Hanzal A, Donnerstein C, Taylor M, Domschke TJ. Social skills, psychological well-being, and the mediating role of perceived stress. Anxiety Stress Coping. 2007;20(3): 321-329. doi: 10.1080/10615800701282252
37. Martin JL, Dean L. The impact of AIDS on gay men: A research instrument. New York, NY: Columbia University; 1988
38. Meyer I. Minority stress and mental health in gay men. J Health Sex Behav. 1995;36:38-56.
39. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
40. Herek GM, Gillis, JR, Cogan JC. Internalized stigma among sexual minority adults: Insights from a social psychological perspective. J Couns Psychol. 2009;56(1):32-43. doi: 10.1037/ a0014672
41. Mirandola M, Gios L, Davis RJ, Furegato M, Breveglieri M, Folch C, Stanekova D, Nita I, Stehlikova D. Socio-demographic factors predicting HIV test seeking behavior among MSM in 6 EU cities. Eur J Public Health. 2017;27(2):313-318. doi: 10.1093/eurpub/ ckw144
42. GayPress.eu. New research: gays in Belarus don’t accept themselves. Dangers of internalized homophobia. GayPress.eu. https://gaypress.eu/2017/11/19/new-research-gays-in-belarus-don-t-accept-themselves-dangers-of-internalized-homophobia/. Published November 19, 2017. Accessed December 23, 2020.
43. Wei C, Cheung DH, Yan H, Jianjun L, Shi L, Raymond HF. The impact of homophobia and HIV stigma on HIV testing uptake among Chinese men who have sex with men: A mediation analysis. J Acquir Immune Defic Syndr. 2016;71(1):87-93.
44. Pyun T, Santos G, Arreola S, Do T, Hebert P, Beck J, Makofane K, Wilson P, Ayala G. Internalized homophobia and reduced HIV testing among men who have sex with men in China. Asia Pac J Public Health. 2014;26(2):118-125.
45. Zhang A, Jang Y. The role of internal health locus of control in relation to self-rated health in older adults. J Gerontol Soc Work. 2017;60(1):68-78. doi: 10.1080/ 01634372.2016.1267672
46. Sandhu D, Shafiq H. To study physical activity and locus of control among adolescents. adolescents. Indian J Educ Stud. 2015;(1):115-121.
47. Victor EA, Haruna K. Relationship between health locus of control and sexual risk behavior. Retrovirology. 2012;9(1):62.
48. Ogunleye AJ, Omojola G, Abikoye GE, Oke OS. Health locus of control, death anxiety and risky sexual behavior among undergraduate students in Nigeria. Psychol Behav Sci. 2015;4(2): 51-57. doi: 10.11648/j.pbs.20150402.13
49. Pharr J, Enejoh V, Mavegam BO, Olutola A, Karick H, Ezeanolue E. Relationships between health locus of control and risky sexual behaviors among Nigerian adolescents. J AIDS Clin Res. 2015;6(6):104. doi: 10.4172/2155-6113.1000471
50. Gwandure C. Dissociative fugue: Diagnosis, presentation and treatment among the traditional Shona people. Open Anthropol J. 2008;1(1):1-10. doi: 10.2147/ 1874912700801010001
51. Remien RH, Stirratt MJ, Nguyen N, Robbins RN, Pala AN, Mellins CA. Mental health and HIV/AIDS: The need for an integrated response. AIDS. 2019;33(9):1411-1420. doi: 10.1097/ QAD.0000000000002227
52. Mangurian C, Cournos F, Schillinger D, Vittinghoff E, Creasman JM, Lee B, Knapp P, Fuentes-Afflick E, Dilley J. Low rates of HIV testing among adults with severe mental illness receiving care in community mental health settings. Psychiatr Serv. 2017;68 (5): 443-448. doi: 10.1176/appi.pd.201600248
53. Mehrotra ML, Glidden DV, McMahan V, Amico KR, Hosek S, Defechereux P, Mayer KH, Veloso VG, Bekker LG, Avelino-Silva VI, Schechter M, Grant RM. The effect of depressive symptoms on adherence to daily oral PrEP in men who have sex with men and transgender women: A marginal structural model analysis of the iPrEx OLE study. AIDS Behav. 2016;20: 1527-1534.
54. Meredith SE, Rash CJ, Petry NM. Alcohol use disorders are associated with increased HIV risk behaviors in cocaine-dependent methadone patients. J Subst Abuse Treat. 2017;83:10-14.
55. Tan D, Holloway IW, Gildner J, Jauregui JC, Alvarez RG, Guilamo-Ramos V. Alcohol use and HIV risk within social networks of MSM sex workers in the Dominican Republic. AIDS Behav. 2017;21:216-227. doi: 10.1007/s10461-017-1896-1
56. Okafor CN, Christodoulou J, Bantjes J, Qondela T, Stewart J, Shoptaw S, Tomlinson M., Rotherman-Borus MJ. Understanding HIV risk behaviors among young men in South Africa: A syndemic approach. AIDS Behav. 2018;22:3962-3970. doi: 10.1007/s10461-018-2227-x
57. Melendez-Torres GJ, Bourne A. Illicit drug use and its association with sexual risk behavior among MSM: More questions than answers? Curr Opin Infect Dis. 2016;29(1): 58-63. doi: 10.1097/QCO.0000000000000234
58. Walter AW, Lundgren L, Umez-Eronini A, Ritter GA. Alcohol use and HIV testing in a national sample of women. AIDS Behav. 2016;20(1):84-96. doi: 10.1007/ s10461-015-1144-5
59. Bengston AM, L’Engle K, Mwarogo P, King’ola N. Levels of alcohol use and history of HIV testing among female sex workers in Mombasa, Kenya. AIDS Care. 2014;26(12): 1619-1624. doi: 10.1080/.9540121.2014.938013
60. Kyle TL, Horigian VE, Tross S, Grober VA, Pereyra M, Mandler RN, Feaster DJ, Metsch LR. Uptake of HIV testing in substance use disorder treatment programs that offer on-site testing. AIDS Behav. 2015;19(3):536-542. doi: 10.1007/s10461-014-0864-2
61. Baliunas D, Rehm J, Irving H, Shuper P. Alcohol consumption and risk of incident human immunodeficiency virus infection: A meta-analysis. Int J Public Health. 2010;55(3):159-166. doi: 10.1007/s00038-009-0095-x
62. Chimoyi L, Tshuma N, Muloongo K, Setswe G, Sarfo B, Nyasulu PS. HIV-related knowledge, perceptions, attitudes, and utilization of HIV counseling and testing: A venue-based intercept commuter population survey in the inner city of Johannesburg, South Africa. Glob Health Action. 2015;8(1):26950. doi: 10.3402/gha.v8.26950
63. Scott-Sheldon LAJ, Carey MP, Carey KB, Cain D, Simbayi LC, Mehlomakhulu V, Kalichman SC. HIV testing is associated with increased knowledge and reductions in sexual risk behaviors among men in Cape Town, South Africa. Afr J AIDS Res. 2013;12(4):195-201. doi: 10.2989/ 16085906.2013.863219
64. Kuehne A, Koschollek C, Santos-Hovener C, Thorlie A, Mullerschon J, Tshibadi CM, Mayamba P, Batemona-Abeke H, Amoah S, Greiner VW, Bursi TD, Bremer V. Impact of HIV knowledge and stigma on the uptake of HIV testing – Results from a community-based participatory research survey among migrants from sub-Saharan Africa in Germany. PLoS One. 2018;13(4):e019424.
65. Ortblad KF, Chanda MM, Mwale M, Haberer JE, McConnell M, Oldenburg CE, Barnighausen T. Perceived knowledge of HIV-negative status increases condom use among female sex workers in Zambian transit towns. AIDS Patient Care STDS. 2020;34(4):184-192. doi: 10.1089/ apc.2019.0266
66. Centers for Disease Control and Prevention. CDC fact sheet: HIV testing in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/ newsroom/ docs/factsheets/hiv-testing-us-508.pdf. Published August, 2016. Accessed December 23, 2020.
67. Lewis JE, Miguez-Burbano MJ, Malow RM. HIV risk behavior among college students in the United States. Coll Stud J. 2009;43(2):475-491.
68. Latkin CA, Mai NVT, Ha TV, Sripaipan T, Zelaya C, Minh NL, Morales G, Go VF. Social desirability response bias and other factors that may influence self-reports of substance use and HIV risk factors: A qualitative study of drug users in Vietnam. AIDS Educ Prev. 2016;28(5): 417-425. doi: 10.1521/aeap.2016.28.5.417
69. Bruce D, Harper GW, Suleta K. Sexual risk behavior and risk reduction beliefs among HIV-positive young men who have sex with men. AIDS Behav. 2013;17(4):1515-1523. doi: 10.1007/ s10461-012-0155-8
70. Reilly KH, Neaigus A, Jennes SM, Wendel T, Marshall DM, Hagan H. Factors associated with recent HIV testing among men who have sex with men in New York City. AIDS Behav. 2014;18(3):297-304. doi: 10.1007/s10461-013-0483-3
71. Braunstein S, Shepard C. The potential pitfalls of targeted screening for acute HIV infection: The view from New York City. J Infect Dis. 2011;204(3):487-488.
72. Centers for Disease Control and Prevention. Effectiveness of prevention strategies to reduce the risk of acquiring or transmitting HIV.
https://www.cdc.gov/hiv/risk/estimates/ preventionstrategies.html. Updated November 12, 2019. Accessed December 23, 2020.