What Can Be Done to Improve the HIV Testing Rate of At-Risk Teenage Boys?

Researchers from the University of Chicago Feinberg School of Medicine published their findings today in Pediatrics on their investigation into HIV testing rates for teenage boys, a group among whom care and suppressed viral loads in HIV are least likely to occur. Their findings are the result of their interim analysis of data from 2018 and 2019 from A Large, Simple Trial Comparing Two Strategies for Management of Anti-Retroviral Therapy (SMART).

In 2017, of the 38,739 new HIV diagnoses in the United States, 21% (8124) were among individuals aged 13 to 24 years. Eighty-seven percent (7125) of these diagnoses were among young men, according to the CDC. However, among the general population of the United States, 14.5% of HIV-positive individuals do not know their disease status. And this rate increases to 51.5% of 13- to 24-year-olds, among whom men who have sex with men account for 80% of new HIV infections, according to the Feinberg investigators.

The patient group they looked at consisted of 699 adolescent men who have sex with men (AMSM), and their average age was 16.6 years (range, 13-18). To qualify for SMART, they had to be aged 13 to 18 years; be assigned male at birth; identify as gay, bisexual, or queer or attracted to cisgender men; have some sexual experience (ie, genital contact); be able to read English or Spanish; and have internet access. The authors chose this group because most studies on HIV testing combine data for teenagers and adults and scant HIV research exists on AMSM. They evaluated the following measures:

• Lifetime HIV test
• Demographics
• Sexual behaviors
• Condom use
• HIV education from school and family
• Sexual health communications with doctors
• HIV knowledge
• Risk attitudes

The results of this interim analysis were mixed. Although testing rates increased with age—5.6% of 13- and 14-year-olds versus 15.8% of 15- and 16-year-olds versus 37.8% of 17- and 18-year-olds—not even 24% had ever been tested for HIV. There was also a dearth of conversations about same-sex sexual behavior (21.3%), HIV testing (19.2%), and sexual orientation (29.2%). Additional reasons for poor testing rates among AMSM included fears of being HIV positive and receiving judgment from family and healthcare providers, closeted status, and lack of transportation, adolescent-friendly testing services, and sex education on HIV and same-sex relationships.

Strong indicators of improved testing rates included sexual experience (odds ratio [OR], 6.54; 95% CI, 3.95-11.49; P <.001) and conversations with doctors (OR, 25.29; 95% CI, 15.91-41.16): 75.4% who spoke to their doctor got tested compared with 10.8% who did not speak and still got tested. The overall results show that HIV testing rates among AMSM rose primarily because AMSM were able to discuss HIV, same-sex sexual behavior, and their sexual orientation with their doctors; could talk to their parents about sex and HIV prevention; were knowledgeable about HIV; felt testing was important; and were empowered to get tested.

“Doctors—pediatricians in particular&mdash;need to be having more frank and open conversations with their male teenage patients, including a detailed sexual history and a discussion about sexual orientation&mdash;ideally a private conversation without parents present,” stated first and senior author Brian Mustanski, PhD, director of the Institute for Sexual and Gender Minority Health and Wellbeing at Feinberg. “If parents ask their teen’s provider to talk about sexual health and testing, this may be enough to start that key dialogue in the exam room, leading to an HIV test.”

The authors also suggest further research on scaling up and expanding HIV testing services for AMSM, education on the testing process, a testing-site locator, motivation via social media, and physician office environment changes that include updating forms to include sexual orientation and reassurance of doctor-patient confidentiality to increase active conversations on HIV testing for AMSM.

Reference

Mustanski B, Moskowitz DA, Moran KO, Rendina HJ, Newcomb ME, Macapagal K. Factors associated with HIV testing in teenage men who have sex with men. Pediatrics. 2020;145(2):e20192322. doi: 10.1542/peds.2019-2322.