Testing the Testers: Are Young Men Who Have Sex With Men Receiving Adequate HIV Testing and Counseling Services?

José A Bauermeister, Jesse M Golinkoff, Willey Y Lin, Kristina F Claude, Keith J Horvath, Nadia Dowshen, Anderson Schlupp, William J Vickroy, Kimberly Desir, Alexander V Lopez, Marné Castillo, Mary Tanney, Taylor A Wimbly, Kingsley Leung, Patrick S Sullivan, Dalisa L Santiago, Rogelio Hernandez, Mary E Paul, Lisa Hightow-Weidman, Sonia Lee, Rob Stephenson, José A Bauermeister, Jesse M Golinkoff, Willey Y Lin, Kristina F Claude, Keith J Horvath, Nadia Dowshen, Anderson Schlupp, William J Vickroy, Kimberly Desir, Alexander V Lopez, Marné Castillo, Mary Tanney, Taylor A Wimbly, Kingsley Leung, Patrick S Sullivan, Dalisa L Santiago, Rogelio Hernandez, Mary E Paul, Lisa Hightow-Weidman, Sonia Lee, Rob Stephenson

Abstract

Background: The United States Centers for Disease Control and Prevention promote HIV testing every 6 months among young men who have sex with men (YMSM) to facilitate entry into the HIV prevention and care continuum. Willingness to be tested may be influenced by testing services' quality. Using a novel mystery shopper methodology, we assessed YMSM's testing experiences in 3 cities and recommend service delivery improvements.

Methods: We assessed YMSM's experiences at HIV testing sites in Philadelphia (n = 30), Atlanta (n = 17), and Houston (n = 19). YMSM (18-24) were trained as mystery shoppers and each site was visited twice. After each visit, shoppers completed a quality assurance survey to evaluate their experience. Data were pooled across sites, normed as percentages, and compared across cities.

Results: Across cites, visits averaged 30 minutes (SD = 25.5) and were perceived as welcoming and friendly (70.9%). YMSM perceived most sites respected their privacy and confidentiality (84.3%). YMSM noted deficiencies in providers' competencies with sexual minorities (63.4%) and comfort during the visit (65.7%). Sites underperformed on Lesbian, Gay, Bisexual, Transgender visibility (49.6%) and medical forms inclusivity (57.95%). Sites on average did not discuss YMSM's relationship context (49.8%) nor provide risk reduction counseling (56.8%) or safer sex education (24.3%). Sites delivered pre-exposure prophylaxis information and counseling inconsistently (58.8%).

Conclusions: Testing sites' variable performance underscores the importance of improving HIV testing services for YMSM. Strategies are recommended for testing sites to promote cultural sensitivity: funding staff trainings, creating systems to assess adherence to testing guidelines and best practices, and implementing new service delivery models.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
HIV testing sites and HIV prevalence per 100,000 people in (A) Philadelphia, (B) Atlanta, and (C) Houston.

References

    1. Fauci AS, Redfield RR, Sigounas G, et al. Ending the HIV epidemic: a plan for the United States. JAMA. 2019;321:844–845.
    1. Goldenberg T, Stephenson R, Bauermeister J. Community stigma, internalized homonegativity, enacted stigma, and HIV testing among young men who have sex with men. J Community Psychol. 2018;46:515–528.
    1. Bauermeister JA, Golinkoff JM, Horvath KJ, et al. A multilevel tailored web app-based intervention for linking young men who have sex with men to quality care (get connected): protocol for a randomized controlled trial. JMIR Res Protoc. 2018;7:e10444.
    1. Merchant RC, Clark MA, Liu T, et al. Comparison of home-based oral fluid rapid HIV self-testing versus mail-in blood sample collection or medical/community HIV testing by young adult black, hispanic, and white MSM: results from a randomized trial. AIDS Behav. 2018;22:337–346.
    1. Liu Y, Silenzio VMB, Nash R, et al. Suboptimal recent and regular HIV testing among black men who have sex with men in the United States: implications from a meta-analysis. J Acquir Immune Defic Syndr. 2019;81:125–133.
    1. DiNenno EA, Prejean J, Irwin K, et al. Recommendations for HIV screening of gay, bisexual, and other men who have sex with men - United States, 2017. MMWR Morb Mortal Wkly Rep. 2017;66:830–832.
    1. Miller RL, Janulis PF, Reed SJ, et al. Creating youth-supportive communities: outcomes from the connect-to-protect(R) (C2P) structural change approach to youth HIV prevention. J Youth Adolescence. 2016;45:301–315.
    1. Tanner AE, Philbin MM, Duval A, et al. “Youth friendly” clinics: considerations for linking and engaging HIV-infected adolescents into care. AIDS Care. 2014;26:199–205.
    1. Philbin MM, Tanner AE, DuVal A, et al. Factors affecting linkage to care and engagement in care for newly diagnosed HIV-positive adolescents within fifteen adolescent medicine clinics in the United States. AIDS Behav. 2014;18:1501–1510.
    1. Mustanski BS, Newcomb ME, Du Bois SN, et al. HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions. J Sex Res. 2011;48:218–253.
    1. Bauermeister JA, Pingel ES, Jadwin-Cakmak L, et al. The use of mystery shopping for quality assurance evaluations of HIV/STI testing sites offering services to young gay and bisexual men. AIDS Behav. 2015;19:1919–1927.
    1. Turan B, Hatcher AM, Weiser SD, et al. Framing mechanisms linking HIV-related stigma, adherence to treatment, and health outcomes. Am J Public Health. 2017;107:863–869.
    1. Wood S, Gross R, Shea JA, et al. Barriers and facilitators of PrEP adherence for young men and transgender women of color. AIDS Behav. 2019.
    1. Meanley S, Gale A, Harmell C, et al. The role of provider interactions on comprehensive sexual healthcare among young men who have sex with men. AIDS Educ Prev. 2015;27:15–26.
    1. Bauermeister JA, Tross S, Ehrhardt AA. A review of HIV/AIDS system-level interventions. AIDS Behav. 2009;13:430–448.
    1. Granatino R, Verkamp J, Stephen Parker RS. The use of secret shopping as a method of increasing engagement in the healthcare industry: a case study. Int J Healthc Manag. 2013;6:114–121.
    1. Rhodes K. Taking the mystery out of “mystery shopper” studies. N Engl J Med. 2011;365:484–486.
    1. Muessig KE, Nekkanti M, Bauermeister J, et al. A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care. Curr HIV/AIDS Rep. 2015;12:173–190.
    1. LeGrand S, Muessig KE, Horvath KJ, et al. Using technology to support HIV self-testing among MSM. Curr Opin HIV AIDS. 2017;12:425–431.
    1. Knight RE, Shoveller JA, Carson AM, et al. Examining clinicians' experiences providing sexual health services for LGBTQ youth: considering social and structural determinants of health in clinical practice. Health Educ Res. 2014;29:662–670.
    1. Levy ME, Wilton L, Phillips G, et al. Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States. AIDS Behav. 2014;18:972–996.
    1. Wilkerson JM, Rybicki S, Barber CA, et al. Creating a culturally competent clinical environment for LGBT patients. J Gay Lesbian Soc Serv. 2011;23:376–394.
    1. Sevelius JM, Patouhas E, Keatley JG, et al. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Ann Behav Med. 2014;47:5–16.
    1. Kazaleh Sirdenis T, Harper GW, Carrillo M, et al. Toward sexual health equity for gay, bisexual and transgender youth: an inter-generational collaborative multi-sector partnerships approach to structural change. Health Educ Behav. In press.
    1. Bauermeister JA, Pingel ES, Sirdenis TK, et al. Ensuring community participation during program planning: lessons learned during the development of a HIV/STI program for young sexual and gender minorities. Am J Community Psychol. 2017;60:215–228.

Source: PubMed

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