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Try out PMC Labs and tell us what you think. Learn More. Contemporary antiretroviral therapy ART can produce viral suppression of HIV, maintain health, and prevent onward HIV transmission from infected persons to their sexual partners, giving rise to the concept of treatment as prevention. Successful implementation of test-and-treat strategies rests on the early detection of HIV infection through voluntary counseling and testing VCT followed by entry and retention in care, ART initiation and adherence, and subsequent viral suppression.

In this study, in-depth interviews were conducted with 96 key informants knowledgeable about racial minority MSM as well as African American MSM community members in Milwaukee, Cleveland, and Miami. Most men in the sample were aware of the availability of testing and knew testing locations, but many voiced great personal ambivalence about being tested, feared knowing their HIV status, expressed concern about stigma and loss of confidentiality, and held beliefs indicative of medical mistrust.

Participants did not spontaneously cite benefits of being tested, risk reduction behavior changes made as Adult wants real sex Portland Oregon 97206 consequence of testing, nor the benefits of testing to get early medical care for HIV infection. Since early in the epidemic, serostatus knowledge has been seen as a means to motivate risk reduction behavior changes to avoid future risk if uninfected, and — if infected — to refrain from practices that could transmit the disease to others and to enter into care.

Numerous studies have examined the impact of VCT on risk behavior patterns, generally confirming reductions in sexual risk practices among persons who learn they are HIV-positive, but less often showing risk behavior reduction among those who learn they are HIV-negative. The role and public health ificance of VCT now extends much further than motivating changes in risk behaviors. Contemporary antiretroviral therapy ART regimens, if initiated early, can dramatically reduce HIV-related illnesses, lessen risk of premature death, and maintain health and quality of life over sustained periods.

Viral suppression produced by ART also greatly reduces infectivity and the likelihood of transmitting the disease from an infected person to sexual partners, giving rise to the conceptualization of HIV treatment as a potentially powerful means of prevention Cohen et al.

Mathematical models show that wide scale viral suppression among persons living with HIV PLH can substantially reduce downstream disease incidence at a community level Granich et al. Gardner and colleagues articulated a continuum of steps needed to achieve viral suppression beginning with HIV testing, progressing through engagement and retention in medical care, and ending with sustained ART treatment adherence resulting in viral suppression.

The initial step in this care continuum is testing to detect HIV infections early, since HIV treatment cannot be initiated without diagnosis. Although the CDC now advocates universal opt-out and routine HIV testing at points of contact with health care systems CDC,young high-risk men—and especially racial and minority men—often have little contact with health service providers. Therefore, regular and frequent VCT continues to be a strategy important for the early identification of HIV infections, for engaging infected persons into care, and—potentially—for moving a greater proportion of PLH toward the goal of viral suppression.

Nearly one in five PLH in the United States remain unaware of their HIV infection CDC, and a large of persons continue to be diagnosed at late, rather than early, stages of their disease course. However, and with the exception of Hoyt et al. Because they are disproportionately burdened by HIV, an important question is whether testing efforts are adequately reaching African American MSM and, if so, whether they are yielding the desired public health benefits. From the time when the disease first appeared in the United States, gay or bisexual men consistently have been most affected by HIV infection.

This disparity is even greater among racial minority MSM. The most shocking disparity is evidenced at the intersection of sexual orientation and race. A of quantitative and epidemiological studies have compared MSM from different racial and ethnic groups Adult wants real sex Portland Oregon 97206 an effort to explain this persistent racial disparity. Literature reviews and published meta-analyses have not yielded persuasive evidence that African American MSM have more frequent unprotected intercourse, more sex partners, or lower rates of condom use than white MSM Millett et al.

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Other research has examined the influences of racism and discrimination, homophobia in the African American community, social and economic oppression, limited health care access, substance use, and beliefs about masculinity as contextual factors that contribute to greater HIV vulnerability for African American MSM Brooks et al. In the qualitative research reported here, African American MSM and key informants in three cities were interviewed to elicit their views about VCT, its perceived benefits and costs, and the extent to which testing influences preventive behaviors.

In-depth interviews were conducted from February through November, in three US cities. At the end of these first round interviews, key informants were asked to identify other key persons who were knowledgeable about the African American MSM community to participate in the in-depth key informant interviews. This iterative process continued until saturation was reached and no new information was emerging. Potential participants were accessed through venues and locations that were identified by the key informants as local gathering places for African American MSM. Participants who had been tested were asked additional questions about their experiences living with the disease if seropositivedisclosure of their status to existing or potential sex partners, and how learning their serostatus had influenced their personal behavior.

Appendix A lists the relevant questions that were posed during the interviews. All interviews were conducted by African American MSM study staff who were trained in qualitative interviewing and who worked collaboratively with project co-investigators to construct the interview guide. Interviews took from 40 to 90 minutes to complete. Interviews were transcribed verbatim and then coded collaboratively by co-investigators and research staff from the three study sites. The coding tree was developed using an iterative and collaborative process.

All team members first read transcripts and identified preliminary themes such as, for example, VCT, condom use, disclosure, and sexual agreements, which were then discussed as a group. After discussion, the coding tree was revised and the process repeated until all team members were satisfied with the final coding scheme and were coding consistently with one another. Dickson-Gomez, J. Owczarzak and C. Sitzler who supervised the formative phase of the research, which confirmed codes were being applied consistently Adult wants real sex Portland Oregon 97206 all study sites and team members.

We used constant comparison to analyze the data to discover patterns of relationships among codes. We compared responses from key informants and community members to see if they differed. We also compared tested versus untested men and seropositive versus seronegative or status-unknown men as these groupings also might reflect different perspectives.

We found no differences between key informants and community members, tested versus untested men, younger vs. The lack of differences between key informants and community members may be because a high proportion of key informants were found, as their interviews progressed, to be African American MSM. The only exception Adult wants real sex Portland Oregon 97206 among key informants who worked as VCT counselors and who promoted testing in their communities.

In thewe specify whether participants were key informants or community members and indicate in which city they lived and their age. All men in the sample said they were aware of locations where VCT was available and were familiar with public health initiatives to promote testing, although individuals differed in terms of their preference for testing at a community agency, a location within the Black community or a health department or care clinic.

The single exception was a faith-based site in one city that, according to participants, supplemented its counseling with religious judgments about the sinfulness of their lifestyle. That site was not well regarded or trusted. If you say well, you have to come down to —for us to test you, then, …I'm too busy for that or I ain't got no bus fare.

The most common response from to the question of how Black MSM feel about HIV testing and counseling was that most men do not want to know their status. For example, one interviewee in Cleveland responded:. Therefore, Black men are leery of getting counseling and being tested. Thank God, it came back negative, but as far as you know, gay people in general just feel like getting tested is like always the moment of truth.

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It could either go up or down hill from here. Maybe you thought you could…. You always hear about that happening, taking only one time.

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So, the more sexually active you get, the more nervous you are to go forth with it [VCT]. This fear caused a great deal of ambivalence among men who, on the one hand, felt concerned that they might have been exposed, but, on the other hand, were afraid of learning their test.

This ambivalence, in turn, often led to procrastination. While a small minority of the participants described getting regular HIV tests, the vast majority of participants who accessed VCT indicated that they were motivated by two primary reasons. For a few participants, VCT was approached tly with a partner to justify discontinuing condoms if they were seroconcordant. For others, the onset of illness symptoms became the precipitant for testing. Even getting tested did not ensure following through to learn the test. For example, one participant described waiting literally years after his first test before he returned to find out thenot wanting the result to affect his sexual life.

Another participant, after being advised that a sex partner was diagnosed with HIV infection, reported waiting nine years before seeking testing until he experienced the onset of symptoms that raised the possibility of HIV infection. About nine years. I lived with not really knowing for nine years. The interviews also revealed local implementation of different strategies to increase HIV testing and minimize barriers to testing.

For example, many participants described venue-based HIV testing in locations such as bathhouses, bars, or house ball events. However, most commented that few men took advantage of the availability of testing in those locations. He, in turn, recruits people he knows to get tested, and receives an incentive payment for each person he recruited who takes an HIV test. Those who were recruited also Adult wants real sex Portland Oregon 97206 an incentive and, in turn, are encouraged to recruit others to get a test.

Ideally, this chain of referrals continues for several waves through high-risk social networks. However, key informants familiar with this method expressed the opinion that the financial incentive, more than desire to know personal serostatus, was responsible for testing. They just wouldn't want to do it just because it's about their health and about living longer and living a prosperous life. They - I mean, it was all an incentive. If we wasn't offering nothing, they wasn't getting tested. Another key informant who worked for an agency that routinely provided financial incentives to African American MSM agreed that approaching men who were unemployed and needed financial resources was key.

Those are the ones that will go out and actually get other people to get tested. Aside from the opportunity to receive financial incentives, there was little consensus about which Black MSM were more or less likely to test. You can get treated. However, another participant commented that Black MSM who tested positive often did not enter medical care:. Because once we start getting people to an undetectable level, I guarantee to you that the spread of HIV would not be as high.

However, this participant and others who expressed these attitudes were generally people who worked or volunteered in AIDS service organizations. By contrast, most community members and key informants who were not involved in HIV prevention or treatment described disadvantages of learning their serostatus, and primarily raised concerns about emotional and structural barriers to accessing care grounded in historic discrimination and stigmatization.

For some men, fear of what they might learn was a strong deterrent to getting testing. One key informant responded:. Don't want to know. They rather not know than know because they feel Adult wants real sex Portland Oregon 97206 it's a death sentence and… - it's so glorified, like, "Oh, my God. I've got HIV. What am I going to do? I'm going to die tomorrow…" Key informant, age 35, Cleveland.

The belief that one has a terminal disease can lead to depression.

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This participant, for example, described being so depressed after he learned his status that he was unable to function normally. Just overwhelmed, became depressed. You know, I became really depressed. I was manager of a nightclub. My driving skills. Other interviewees who learned they were seropositive voiced similarly strong emotional reactions. I thought I was going to die. I thought I was going to look like the pictures of people in Africa. I just thought it was all over. And I thought I would never date again.

All the wasted money I spent thinking I was about to die partying. Even some participants who knew about the availability of effective medications reported depression after learning that they were HIV positive. I have not accomplished anything with my life.

I put myself in rehab. I Adult wants real sex Portland Oregon 97206 myself back in school…. Even though HIV medications are available, some men expressed doubt that they can live a long and relatively normal life after receiving a seropositive test result, a belief that may also stem from a backdrop of general mistrust of the health care system.

Some men related their distrust back to historical mistreatment of African Americans, others to a generalized distrust of government, and still others were wary about the confidentiality of their test given public health reporting requirements. You know, it plays a part. You know, we already, as a culture, don't trust doctors, you know, especially Adult wants real sex Portland Oregon 97206 you're from an older home to where, like, you know, you're all perfectly healthy, and then you go to the doctor, and all of a sudden, you're in the hospital. Like that whole myth is like really prevalent.

Learning that one is HIV seropositive can also have negative consequences for relationships that one partner had assumed was monogamous. He is 22 and was with someone for four years. The third year they decided not to use a condom. Some men even acknowledged withholding or misrepresenting personal information from a counselor during the VCT session, either because they were concerned that their would be divulged or because of perceived racial, sexual orientation, or ethnic differences between the VCT counselor and themselves.

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