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Suboptimal Recent and Regular HIV Testing Among Black Men Who Have Sex With Men in the United States

Implications From a Meta-Analysis

Liu, Yu, PhDa; Silenzio, Vincent M. B., MDb; Nash, Robertson, PhDc; Luther, Patrick, MSd; Bauermeister, Jose, PhDe; Vermund, Sten H., MD, PhDf; Zhang, Chen, PhDg

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1, 2019 - Volume 81 - Issue 2 - p 125–133
doi: 10.1097/QAI.0000000000002013
Critical Review
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Background: The continuum of HIV care among black men who have sex with men (BMSM) continues to be the least favorable in the United States. BMSM are disproportionally HIV-infected-but-unaware, despite expanded HIV testing efforts among this subgroup.

Methods: We meta-analytically analyzed various HIV testing patterns [lifetime, after 24 months, after 12 months, after 6 months, and frequent (every 3–6 months) testing] among BMSM using the PRISMA guideline. PubMed, MEDLINE, Web of Science, and PsycINFO were searched for relevant articles, reports, conference proceedings, and dissertations published between January 1, 1996, and April 25, 2018. Two independent investigators reviewed and abstracted data into a standardized form. We used the DerSimonian–Laird random-effect model to pool the HIV testing prevalence and I-square statistics to measure heterogeneity. Funnel plots and Egger tests were used to assess for publication bias. We also performed subgroup and meta-regression analyses to explore aggregate-level characteristics that explain the heterogeneity across studies.

Results: Our meta-analysis includes a total of 42,074 BMSM pooled from 67 studies. Lifetime HIV testing prevalence was high, 88.2% [95% confidence interval (CI): 86.2% to 90.1%], but recent (after 6 months = 63.4%; 95% CI: 59.3% to 67.4%) and frequent (42.2%, 95% CI: 34.1% to 50.3%) HIV testing prevalence was low. Meta-regression suggests that younger age (borderline significant), lower annual income, and homelessness were correlated with lower lifetime/recent HIV testing prevalence; while ever having condomless insertive/receptive sex, alcohol consumption, and illicit drug use were associated with higher lifetime/recent HIV testing prevalence.

Conclusions: Recent and frequent HIV testing remains suboptimal among BMSM. Future testing programs should prioritize strategies to enhance self-initiated, regular HIV testing among BMSM.

Departments of aPublic Health Sciences; and

bPsychiatry, University of Rochester Medical Center, Rochester, NY;

cDepartment of Medicine, Vanderbilt University Medical Center, Nashville, TN;

dNashville Council on AIDS, Resources, Education and Support (CARES), Nashville, TN;

eSchool of Nursing, University of Pennsylvania, Philadelphia, PA;

fDepartment of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, CT; and

gSchool of Nursing, University of Rochester Medical Center, Rochester, NY.

Correspondence to: Yu Liu, PhD, Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Boulevard, Box 420644, Rochester, NY 14642 (e-mail: yu_liu@urmc.rochester.edu).

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received October 15, 2018

Accepted February 13, 2019

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