Frequency of HIV testing among community samples of gay and bisexual men in the UK

Background: Men who have sex with men (MSM) remain the group most at risk of acquiring HIV in the UK, and an estimated one in five HIV-positive MSM is undiagnosed. HIV testing guidelines recommend at least annual testing, with more frequent testing (up to every three months) recommended for those at higher risk of HIV acquisition. Mathematical modelling suggests that increased HIV testing in combination with improved access to treatment could reduce incidence, but little is known about how frequently MSM in the UK actually test for HIV.
Methods: We examined data from 2992 HIV-negative/untested MSM in comparable cross-sectional surveys in Edinburgh, Glasgow and London in 2011 and a Scotland wide online questionnaire of MSM between November 2012 and February 2013. The frequency of HIV tests in the previous two years (less than 4 vs. 4+ tests) was measured. In the online survey, MSM who reported testing ‘every 3-6 months’ were coded as having had 4+ tests in the previous
two years.
Results: The mean age of the sample was 34.1 years (range 18-83, SD=11.63). Most identified as gay and 84.8% reported anal intercourse (AI) in the previous 12 months; 16.1% reported 10+ AI partners. Overall, 1512 MSM (50.5%) reporting having had an HIV test in the previous 12 months. Frequent HIV testing was reported by 510 MSM (18.2%). In multivariate analysis adjusting
for age, survey and sexual behaviour, the odds of frequent testing were significantly lower for men in London (AOR=0.54, 95% CI 0.41-0.71) and the online survey (0.77, 0.61-0.98) compared with Glasgow/Edinburgh and for men aged 36-45 years (0.53, 0.39-0.73) and 46+ years (0.61, 0.44-0.84) compared with those aged =25 years. The odds were higher for men reporting a sexually
transmitted infection (STI) (1.71, 1.30-2.25), 10+ sexual partners (1.49, 1.11- 2.00) and 10+ AI partners (2.33, 1.67-3.25) in the previous 12 months.
Conclusion: Half of the MSM in our community based sample reported a recent HIV test, but fewer than one in five reported frequent HIV testing. Although the likelihood of testing was raised among men reporting more sexual/AI partners and STIs, there were significant regional and demographic differences between frequent and non-frequent testers. Regional differences in the roll out, uptake and effectiveness of HIV testing campaigns should be considered alongside efforts to increase the frequency of testing, as should the potential impact of the introduction of self testing kits for HIV in the UK.