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HIV testing among gay men in Edinburgh and the Lothians

Conclusions

Keeping in mind that the original ‘Testing Barriers’ research was conducted in both Edinburgh and Glasgow, comparing data collected for that report suggests aggregate levels of unprotected anal intercourse (UAI) have increased from 37% in 2000 to 43% in 2002. There was a similar increase when the Testing Barriers data was compared with data collected for the Gay Men’s Task Force (Hart et al, 1999) which reported 32% in 1996. As in 2000, gay men engaging in UAI with partners of unknown status were aware of what they were doing in terms of personal risk taking. Those at most risk are likely to say they take more risks now than they used to.

There is evidence for change in terms of increases in levels of HIV testing from an average of 55% in 2000 (Flowers et al, 2000) to 62% in 2002. This represents a continuing trend with 51% reported by GMTF in 1996 (Hart et al, 1999). The impact of new treatments has undoubtedly contributed to this trend but not all recent developments reinforce the advantages of testing. Recent studies on increases in drug resistant strains of HIV and the psychosocial impacts of recent court judgements put greater burdens and responsibilities on people with HIV.

Only 5% (14 men) self-reported a positive HIV status indicating that seroprevalence remains quite low. However, in the light of the findings above, the importance of testing is highlighted for the group of gay men who are HIV positive but who do not know it. For some of these men there would be clear medical advantages in knowing their status and accessing appropriate medical care. There are clearly a number of men who have had UAI with people of unknown status in the past 5 years who have not had a test. They perceive barriers to testing, the most common of which is fear of a positive result associated with beliefs about what it means to be positive.

One of the key issues associated with what it means to be HIV positive was the very high level of stigma and discrimination towards people with HIV. HIV positive status is widely understood to bring with it stigma and discrimination, associated physical and mental health problems and sexual problems (e.g. dealing with disclosure issues, responsibility for condom use, lack of sexual partners). The stigma associated with HIV positive status extends to the testing process itself and, as the research shows, HIV testing remains a personal issue with a large number of men choosing not to tell their friends if they have had a test. 53% of the sample said they were unsure if their friends had had a test and it appears that gay men anticipate and avoid the issue of status disclosure even when considering whether to have a test.

This research underlines the complexity of gay men’s responses to HIV and the importance of psychosocial factors in contributing to their testing decisions. The Testing Barriers Project has adopted a community development approach to dealing with barriers to testing including information and training for volunteers and bar staff on the commercial gay scene, peer education initiatives, involving gay men with HIV in developing strategies to tackle HIV stigma and discrimination and organising various health promotion events in gay venues. The findings of this report suggest these methods of intervention are appropriate rather than any specifically pro-testing campaign at this time.

A copy of the full report, HIV Testing In Edinburgh And The Lothians, is available from Steve O’Donnell, Testing Barriers Project Manager, Gay Men's Health, 10a Union Street, Edinburgh EH1 3LU.