Australian gay men

A study from Australia¹ analysed some of the thought processes that might lie behind failure to test or re-test. It found that gay and bisexual men who had not recently tested for HIV often believed that they had not taken enough risks to justify a test. Some also said that the psychological impact of a positive diagnosis would be too great. The researchers recommend health-promotion interventions which would help men reassess their own thinking about HIV tests.

Psychologists recruited 97 men at gay bars in Melbourne. Men taking part had not been tested for HIV in the last four years and had never received a positive diagnosis.

Very few of the participants had a strong intention to get tested in the next few months even though two-fifths had had unprotected anal intercourse with more than one partner in the last year.

Participants were asked to identify what thoughts the suggestion of taking a test would prompt in them. A list of ‘prompt’ thoughts was provided, although participants were able to add in other thoughts. It’s notable that only negative thoughts were suggested. The two most common thoughts, suggested by at least two-thirds of the group, were:

• “I don’t really need a test, because I haven’t taken any/many risks, so I’m pretty sure I haven’t got HIV”.
• “I don’t really need a test, because I haven’t had any symptoms that might suggest I’ve got HIV”.

The researchers then analysed the correlations between the different thoughts in order to put them into groups (‘factors’). The top four factors were:

• The first, and most important, factor grouped together a number of perceived long-term problems associated with having HIV. The most important was: “If I find out I’ve got HIV, that might wreck my relationship with my boyfriend/partner. It’s better not to find out.” Another thought in this factor noted that the boyfriend may realise that his partner had not been monogamous. Several other thoughts included the phrase “it’s better not to find out” and mentioned changes to one’s sex life, being set apart from friends, depression and stress.
• The second factor grouped together concerns about the confidentiality of the HIV test. The most important statement in this group was: “I don’t want to be listed on some file as having HIV. I’m not sure the test result would remain private.” A similarly worded statement about being listed as having gone for testing also scored highly.
• The third factor linked together thoughts about short-term problems associated with the test, including dislike of needles and not having enough time.
• The fourth factor brought together thoughts suggesting that HIV testing was unnecessary. One thought suggested that the respondent had not taken many risks, another that HIV was uncommon in the respondent’s social circle, and another that the respondent had no symptoms of HIV infection.

Those men who had had unprotected anal intercourse with more than one man in the last year tended to report a higher number of negative thoughts than men who had taken fewer sexual risks. This group also had higher rates of testing than the rest of the sample, which the researchers believe means that they had some awareness of their level of risk, and yet, like all others in the survey, these men had not tested in the last four years, even though their behaviour could mean that they had more reason to fear a positive result. The researchers suggested that many of the thoughts of these men are in fact rationalisations, and that the greater risk “produced a need to seize on any plausible means” of explaining the decision not to test.

The researchers suggested that it might be possible to design interventions which would help men to understand that their thoughts are in fact rationalisations. A possible intervention would involve presenting men with a list of justifications for not being tested, asking them to say which ones figure in their own thinking, and then asking them to carefully evaluate the adequacy of each one. The authors also suggest that rather than trying in vain to get men to see the benefits of testing, health promoters could also focus on ‘losses’ - not the disadvantages of testing, but the disadvantages of not having tested early enough.