Date of Conferral

2020

Degree

Ph.D.

School

Health Services

Advisor

David Segal

Abstract

Black men who have sex with men (BMSM) are more likely unaware of their HIV status, are less likely to get tested annually, and prefer to use HIV testing services (HTS) in the nonclinical settings, compared to other MSM subgroups. Guided by the behavioral model for vulnerable populations and a cross-sectional quantitative design, three substudies were conducted using secondary data for 1189 BMSM, 18 years or older, from the HIV Prevention Trial Network 061 Study. Chi-square, multinomial logistic regression (MLR), and z-test methods were used to examine the association between population characteristics (predisposing, enabling, and need factors) and HIV testing history levels in the past 12 months (never tested; tested once; tested more than once) between the clinical and nonclinical settings. Reported results showed no statistically significant difference between settings. However, HIV testing history levels in the past year were significantly associated with age (inversely) and positively with education attainment (predisposing factors) in both settings, and negatively with health insurance status (enabling factor) in the clinical setting. BMSM aged 18-28 were 75% more likely, the uninsured were 89% less likely, and those with some college were 10% less likely to use HTS in the nonclinical relative to the clinical setting. In bivariate MLR, the uninsured were less likely (OR = .67, p = .11) in the prior year to get tested more than once in the nonclinical setting compared to the clinical setting (OR = 1.28, p = .35). The positive social change impact of the revealed associations includes the potential to inform a combination of targeted and routine-based strategies to promote more frequent testing to help detect acute infections and reduce transmissions from those unaware of their status.

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