Gay men and self-perception of risk

When surveys are done of people who have not tested for HIV or have actively turned down the offer of a test, the primary reason cited is that people do not believe they have been at risk and therefore do not need to test. In many cases people will be correct in their belief.  Yet surveys continue to find that people with HIV who are undiagnosed consistently underestimate their risk of infection.

The latest in a series of surveys, for instance, that have given anonymous oral HIV tests to gay men frequenting bars, clubs and saunas in London, Brighton, Manchester, Glasgow and Edinburgh have consistently found that from a third to nearly a half of gay men who have HIV do not know it.¹ Eighty per cent of undiagnosed men reported having had an HIV test in the past, though 8% reported not knowing their test result.

When asked about their perception of their HIV status, only 3.8% of the undiagnosed men thought that they might be HIV-positive, whereas 62.3% thought they were HIV-negative.

A study conducted in 2005 suggested that GUM clinics in the UK coulddo more to reduce the number of gay men with undiagnosed primary HIV infection.²

At the time the data was collected, 86% of gay men attending sexual health services were offered an HIV test. There were a range of reasons why clinics were not offering tests, including, in 5% of cases, because risky sex had occurred within the ‘window period’ for the development of HIV antibodies. This period can last up to three months, but newer HIV-testing technology is now often able to detect HIV infections ten days to two weeks after exposure.

Surprisingly, the investigators also found that clinics were three times more likely to offer tests to individuals attending for routine sexual-health screens than to patients who were seeking care because they had symptoms of a sexually transmitted infection, even though the presence of such symptoms can be a good indicator of recent HIV-risk activity.

The offer of an HIV test was accepted by 82% of men. Commonly reported reasons for refusing an HIV test were: HIV-risk activity was within the ‘window period’ (23%); low self-perceived risk (13%); anxiety about the result (11%); and deferral of testing to a later date (9%).

People who underestimate their own risk of having HIV will also underestimate their risk of transmitting it. A 2006 study from London³ found that 11 out of 75 undiagnosed men who originally reported not having UAI with partners of unknown or discordant HIV status, reported having what they thought was concordant UAI (i.e. they had UAI with men that they perceived to be HIV-negative). Two-thirds of these undiagnosed men believed they were HIV-negative.

“Just under half reported testing negative in the twelve months leading up to the surveys, suggesting many were recent seroconverters,” the researchers wrote. “With high viral loads at seroconversion, they could have been highly infectious, but were basing their sexual risk decisions on an assumption of negativity.”