A new survey by the Kaiser Family Foundation finds that despite increasing HIV rates among gay and bi men in the U.S., only 30 percent of them have been tested for the virus within the last year. Even worse, 44 percent of gay and bi men under the age of 35 reported having never been tested for HIV in their entire lives.
Unsurprisingly, the study also found that these gay and bi men were ill-informed about other aspects of HIV and its treatment, but it also seems that it wasn’t entirely their fault. For example, 56 percent said that a doctor had never recommended they get tested for HIV, and 61 percent rarely or never discuss HIV when they visit their doctor. As a result, only 32 percent knew that new HIV infections are on the rise among gay and bi men, and 22 percent actually thought infections were decreasing.
This deficit in testing serves as a significant barrier for preventing new infections. A study recently found that if someone who is diagnosed HIV-positive uses aniretroviral therapy to reduce their viral load to “undetectable” levels, it is virtually impossible for them to transmit the virus to others. Similarly, if those who are negative take a daily regiment of antiretroviral medication known as pre-exposure prophylaxis (PrEP) — as the World Health Organization now recommends — it can be 100 percent effective at preventing HIV infection. Basically, if those who are HIV-positive begin treatment and those who are negative take steps to prevent infection, the spread of the virus could be significantly curbed.
But the gay and bi men in the Kaiser study didn’t know much about this research. Only 25 percent understood that being treated for the virus helps prevent future infection (“treatment as prevention”), and 46 percent were not even aware that guidelines recommend that antiretroviral treatment begin as soon as there is a positive diagnosis. These men essentially did not understand that by not getting tested and remaining ignorant of their status, they are actually at much higher risk of helping to spread HIV to others.
Similarly, only 26 percent of the men in the survey knew about PrEP. Eight in ten — a full 80 percent — said that they have heard “only a little” or “nothing at all” about the new prevention option.
Anti-HIV stigma within the gay community may very well be contributing to the problem. Two thirds of gay and bi men say they would be uncomfortable being in a long-term sexual relationship with someone who is HIV-positive and 77 percent would be uncomfortable having casual sex with someone who is HIV-positive — and the numbers are even higher for those under the age of 35. This is in spite of the fact that, given the new treatment as prevention options, having sexual relations with someone who doesn’t know his status is actually quite riskier than someone who has been diagnosed as positive and started treatment.
Stigma is also perpetuated by laws that attempt to criminalize the transmission of HIV. Several studies have found that these archaic and outdated laws can actually discourage individuals from getting tested because they believe they can’t be prosecuted so long as they don’t know their status. The U.S. Department of Justice has recommended that these laws be repealed because they do not jibe with modern science on the virus, and the Iowa Supreme Court recently overturned an HIV transmission conviction, noting that the defendant’s viral load was undetectable and thus it was not prudent for the law to assume transmission was possible.
Kaiser estimates that about 13 percent of gay men are HIV positive. The Centers for Disease Control and Prevention suggests that in major cities, it could be as high as 20 percent, with as many as a third not knowing that they are positive.