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      Barriers to HIV testing and characteristics associated with never testing among gay and bisexual men attending sexual health clinics in Sydney


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          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).


          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.


          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).


          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.

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          HIV infection: epidemiology, pathogenesis, treatment, and prevention.

          HIV prevalence is increasing worldwide because people on antiretroviral therapy are living longer, although new infections decreased from 3.3 million in 2002, to 2.3 million in 2012. Global AIDS-related deaths peaked at 2.3 million in 2005, and decreased to 1.6 million by 2012. An estimated 9.7 million people in low-income and middle-income countries had started antiretroviral therapy by 2012. New insights into the mechanisms of latent infection and the importance of reservoirs of infection might eventually lead to a cure. The role of immune activation in the pathogenesis of non-AIDS clinical events (major causes of morbidity and mortality in people on antiretroviral therapy) is receiving increased recognition. Breakthroughs in the prevention of HIV important to public health include male medical circumcision, antiretrovirals to prevent mother-to-child transmission, antiretroviral therapy in people with HIV to prevent transmission, and antiretrovirals for pre-exposure prophylaxis. Research into other prevention interventions, notably vaccines and vaginal microbicides, is in progress. Copyright © 2014 Elsevier Ltd. All rights reserved.
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            HIV testing within at-risk populations in the United States and the reasons for seeking or avoiding HIV testing.

            We determined proportions of high-risk persons tested for HIV, the reasons for testing and not testing, and attitudes and perceptions regarding HIV testing, information that is critical for planning prevention programs. Cross-sectional interview study of persons at high risk for HIV infection (men who have sex with men [MSM]; injection drug users [IDUs]; and heterosexual persons recruited from gay bars, street outreach, and sexually transmitted disease clinics) among six states participating in the HIV Testing Survey (HITS) in 1995 to 1996 (HITS-I) and 1998 to 1999 (HITS-II). Overall testing rates were lower in the HITS-I (1226/1599 [77%]) than in the HITS-II (1375/1711 [80%]) (p =.01). Persons or=25 years old (HITS-I: 71% vs. 78%, respectively, p=.007; HITS-II: 63% vs. 85%, respectively, p<.001). The main reasons for testing and not testing were the same in both surveys, but the proportions of reasons for not testing differed (e.g., "unlikely exposed to HIV" [HITS-I (17%) vs. HITS-II (30%), p<.0001], "afraid of finding out HIV-positive" [HITS-I (27%) vs. HITS-II (18%), p<.0001]). Attitudes regarding HIV testing differed among tested and untested respondents, especially among MSM. HIV testing rates were higher in the HITS-II, but testing rates decreased among the youngest respondents. Denial of HIV risk factors and fear of being HIV-positive were the principal reasons for not being tested. Availability of new HIV therapies may have contributed to decreased fear of finding out that one is HIV infected as a reason to avoid testing. The increased proportion of persons at risk who did not test because they believed they were unlikely to have been exposed highlights the need for prevention efforts to address risk perceptions.
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              Innovation in sexually transmitted disease and HIV prevention: internet and mobile phone delivery vehicles for global diffusion.

              Efficacious behavioral interventions and practices have not been universally accepted, adopted, or diffused by policy makers, administrators, providers, advocates, or consumers. Biomedical innovations for sexually transmitted disease (STD) and HIV prevention have been embraced but their effectiveness is hindered by behavioral factors. Behavioral interventions are required to support providers and consumers for adoption and diffusion of biomedical innovations, protocol adherence, and sustained prevention for other STDs. Information and communication technology such as the Internet and mobile phones can deliver behavioral components for STD/HIV prevention and care to more people at less cost. Recent innovations in STD/HIV prevention with information and communication technology-mediated behavioral supports include STD/HIV testing and partner interventions, behavioral interventions, self-management, and provider care. Computer-based and Internet-based behavioral STD/HIV interventions have demonstrated efficacy comparable to face-to-face interventions. Mobile phone STD/HIV interventions using text-messaging are being broadly utilized but more work is needed to demonstrate efficacy. Electronic health records and care management systems can improve care, but interventions are needed to support adoption. Information and communication technology is rapidly diffusing globally. Over the next 5-10 years smart-phones will be broadly disseminated, connecting billions of people to the Internet and enabling lower cost, highly engaging, and ubiquitous STD/HIV prevention and treatment support interventions.

                Author and article information

                J Int AIDS Soc
                J Int AIDS Soc
                Journal of the International AIDS Society
                International AIDS Society
                27 August 2015
                : 18
                : 1
                [1 ]The Kirby Institute, UNSW Australia, Sydney, Australia
                [2 ]Short Street Sexual Health Centre, St George Hospital, Sydney, Australia
                [3 ]Centre for Social Research in Health, UNSW Australia, Sydney, Australia
                [4 ]Western Sydney Sexual Health Centre, Western Sydney Local Health District, Sydney, Australia
                [5 ]The Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
                [6 ]Albion Centre, Sydney, Australia
                [7 ]School of Public Health and Community Medicine, UNSW Australia, Sydney, Australia
                [8 ]North Shore Sexual Health Service, Royal North Shore Hospital, Sydney, Australia
                [9 ]Sydney Medical School, University of Sydney, Sydney, Australia
                [10 ]Sydney Sexual Health Centre, Sydney Hospital, Sydney, Australia
                [11 ]St Vincent's Centre for Applied Medical Research, UNSW Australia, Sydney, Australia
                [12 ]NSW State Reference Laboratory for HIV, St Vincent's Hospital, Sydney, Australia
                Author notes
                [§ ] Corresponding author: Damian P Conway, The Kirby Institute, UNSW Medicine, Wallace Wurth Building, Sydney, NSW 2052, Australia. Tel: +61 2 9385 0900. Fax: +61 2 9385 0920. ( dconway@ 123456kirby.unsw.edu.au )

                Sydney Rapid HIV Test Study (asterisk indicates reference group member) Dr Damian Conway* (principal investigator), A/Prof Rebecca Guy*, Phillip Keen*, The Kirby Institute, UNSW Australia, Sydney, NSW 2052. A/Prof Martin Holt*, Centre for Social Research in Health, UNSW Australia, Sydney, NSW 2052. Site investigators & coordinators: A/Prof Anna McNulty*, Timmy Lockwood & Simon Wright, Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000; Dr Deborah Couldwell*, Karen Biggs & Jill Townsend, Western Sydney Sexual Health Centre, Western Sydney Local Health District, NSW 2150; Prof Don Smith*, Anthony Price & Maggie Smith, Albion Centre, Surry Hills, NSW 2010; and Dr Stephen Davies*, Andrew Koh & Molly Florance, North Shore Sexual Health Service, Royal North Shore Hospital, St Leonards, NSW 2065. Staff training & quality management: Philip Cunningham*, Craig Leeman & Leon McNally (State Reference Laboratory for HIV, Darlinghurst, NSW 2010; and Kim Wilson, Sue Best, Joe Vincini & Sally Land, National Serology Reference Laboratory, Fitzroy, VIC 3065. Staff & laboratories conducting laboratory tests on patient specimens: Prof William Rawlinson, A/Prof Peter Robertson & Michael Fennell, South Eastern Area Laboratory Services, Randwick, NSW 2031; Dr Matthew O'Sullivan, Ioanna Kapitanos & David Dickeson, Institute for Clinical Pathology & Medical Research, Westmead, NSW 2145; and A/Prof Suran Fernando & Robert Fulton, Pacific Laboratory Medicine Services, St Leonards, NSW 2065.

                © 2015 Conway DP et al; licensee International AIDS Society

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Research Article

                Infectious disease & Microbiology
                barriers to hiv testing,never testing,gay and bisexual men,sexual health clinics


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