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HIV Testing Among Middle-Aged and Older Men Who Have Sex With Men (MSM): A Blind Spot?
Alvaro Francisco Lopes Sousa1,2, Artur Acelino Francisco Luz Nunes Queiroz1,3, Inês Fronteira2
11 Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo (USP), Brazil.
Abstract:
Middle-aged and older men who have sex with men (MSM) are one of the most underestimated populations with regard to HIV/AIDS infection, despite the worldwide trend of increasing prevalence in recent years. This population also has low rates of testing, although rare studies are done exclusively with middle-aged and older MSM assessing the factors associated with this prevalence. Thus, based on data from an exclusive online survey with middle-aged and older MSM who use geolocation-based dating applications, the purpose of the study was to analyze factors associated with not taking the HIV test among middle-aged (50 years old) and older MSM in Brazil. Using a modification of time-location sampling adapted to virtual reality, 412 volunteers were approached in Grindr®, Hornet®, SCRUFF®, and Daddyhunt®. The multivariate logistic regression model was adopted to produce adjusted odds ratios (ORa), considering a significance level at .05. There were factors associated with not taking the test: being in a relationship (ORa: 0.24; 95% CI [0.10, 0.53]); knowing partner through the applications (ORa: 1.84; 95% CI [1.07, 3.15]); not knowing the serological status (ORa: 5.07; 95% CI [1.88, 13.67]); ejaculating outside of anal cavity (ORa: 1.79; 95% CI [1.04, 3.05]); practicing sex without penetration (ORa: 2.30; 95% CI [1.17, 4.50]); not taking the test as a form of prevention (ORa: 2.83; 95% CI [1.05, 7.68]); and rarely using Viagra in sexual intercourse (ORa: 1.91; 95% CI [1.20, 3.65]). There is a blind spot in the prevalence of HIV testing in older MSM because this population is not being covered by services, which compromises the overall response to HIV, the goals set for universal health coverage.
Insights
Older men who have sex with men (MSM) show low HIV testing rates. Factors like relationship status and sexual practices are linked to not taking the HIV test, highlighting a gap in services for this population.
Area of Science:
- Public Health
- Epidemiology
- Sexual Health
Background:
- Middle-aged and older men who have sex with men (MSM) are an underrepresented group in HIV/AIDS research and interventions.
- This demographic exhibits low rates of HIV testing, despite increasing global prevalence trends.
- Existing studies rarely focus exclusively on older MSM to understand HIV testing behaviors.
Purpose of the Study:
- To investigate factors associated with not undergoing HIV testing among middle-aged and older MSM in Brazil.
- To analyze data from an online survey targeting MSM who use geolocation-based dating applications.
Main Methods:
- An online survey was conducted using a modified time-location sampling method adapted for virtual environments.
- 412 participants were recruited via popular geolocation-based dating applications (Grindr®, Hornet®, Scruff®, Daddyhunt®).
- Multivariate logistic regression analysis was employed to determine adjusted odds ratios (ORa) at a significance level of .05.
Main Results:
- Factors associated with not taking the HIV test included being in a relationship (ORa: 0.24), knowing partners through apps (ORa: 1.84), and not knowing serological status (ORa: 5.07).
- Specific sexual practices like ejaculating outside the anal cavity (ORa: 1.79), sex without penetration (ORa: 2.30), and infrequent Viagra use (ORa: 1.91) were also linked to lower testing rates.
- Not using HIV testing as a preventive measure was significantly associated with not testing (ORa: 2.83).
Conclusions:
- A significant gap exists in HIV testing coverage for older MSM, indicating a blind spot in public health services.
- This lack of service coverage compromises the overall response to HIV and hinders universal health coverage goals.
- Targeted interventions and accessible testing strategies are crucial for this understudied population.
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