A Qualitative Analysis of HIV Testing Behaviors among Black MSM in Atlanta, Georgia, USA SOPHIA HUSSEN MD, MPH, ROBERT STEPHENSON PHD, CARLOS DEL RIO, MD, LEO WILTON PHD, JERMEL WALLACE MHS, AND DARRELL WHEELER PHD ON BEHALF OF HPTN 061

Maintenance Testers described testing as a part of routine self-care. “It was just something that I would normally do. I normally get tested every six months cause I knew once I became sexually active that was just the right thing to do—that’s how I was brought up, I guess.” Risk-Based Testers sought testing based on changes in relationship status or sexual activity. “Last time I was tested before that was like, it must have been about five years and then the time before that was probably five years, cause I lost a lover to the virus in 1989 and…I was getting tested regularly for the next couple of years after that, but then after that, I kind of stopped.” Convenience Testers were influenced by structural issues like location and cost. “The only reason why I got tested is cause a friend of mine worked for an organization...and they brought a test with them to my house. Then after that test, I went to gay pride and I took a test in the park.” Test Avoiders cited fear as a major reason for not testing or failing to follow up on test results. “I could've went back but, it just didn't fit, the fear of the results being positive. The fear of hearing that, that's the main thing-- nobody wants to hear that.” Typology of HIV Testing Patterns

Characterization of Socio-Contextual Constructs Maintenance Testers Risk-Based Testers Convenience Testers Test Avoiders Age (Median Age Range) Gay IdentityMajority gay- identified Split between gay-identified and bisexual- identified Majority bisexual- identified Majority gay- identified and/or transgendered Salience of Sexuality vs Race Sexuality > RaceSexuality = Race Race > SexualitySexuality > Race Stigma and Discrimination FrequentOccasional Frequent and Severe Healthcare Access (any) Majority (8/9)Majority (6/7)Half (2/4)Half (3/6)

Dichotomous conceptualizations of HIV testing are insufficient for understanding testing behaviors over time. There is considerable diversity among Black MSM with respect to HIV testing, age, identity, stigma, and healthcare access. Future work should test and apply this framework in larger samples and different geographic settings. Conclusions

HPTN 061 Acknowledgements Clinical Research Sites, Staff and CABs Emory University Fenway Institute George Washington University School of Public Health and Health Services Harlem Prevention Center New York Blood Center San Francisco Department of Public Health UCLA Vine Street Clini National Institutes of Health: NIAID, NIDA & NIMH Protocol Co-Chairs: –Beryl Koblin, PhD –Kenneth Mayer, MD –Darrell Wheeler, PhD, MPH HPTN 061 Protocol Team Members HPTN 061 Study Participants HPTN Network Laboratory, Johns Hopkins Univ. School of Medicine Statistical and Data Management Center, SCHARP HPTN CORE Operating Center, FHI 360 Black Gay Research Group HPTN 061 Black Caucus HPTN Scholars program Funded by NIH (NIAID/NIDA/NIMH) under Cooperative Agreement # UM1 AI068619