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Ī recent study exploring HIV testing frequency among MSM in the UK identified variation in testing practices among young men (aged ≤25 years) with 38.6% reporting testing once or less in the past 2 years, and 27.5% reporting at least four HIV tests in the same period. However, recent research in Scotland and the rest of the UK has shown that although HIV testing rates have been increasing among gay, bisexual and other MSM, increases in testing levelled off in the years 2008–2011, and that testing frequency does not meet levels recommended in current guidelines. Increases in HIV testing have been widely reported in high income countries.
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For those at highest risk of infection, UK national guidelines on safer sex suggest that it may be appropriate to (re)test as frequently as every 3 months, however, there is little consensus on what is defined as ‘high(est) risk’. Current UK policy on HIV testing recommends that MSM attend for testing at a minimum annually, but more often if engaging in high risk sex, specifically, unprotected anal intercourse Footnote 2 (UAI) with multiple partners. In Scotland, and the rest of the UK, men who have sex with men Footnote 1 (MSM) remain one of the groups most vulnerable to HIV. Indeed, if PrEP is to be made routinely available it is likely that frequent testing, including self-testing, will play a critical role in ensuring success. The increasing focus on biobehavioural approaches to HIV prevention such as Treatment as Prevention (TasP) and Pre-Exposure Prophylaxis (PrEP) foreground the importance of regular testing within the ever changing HIV prevention landscape. Late diagnosis is a key factor in HIV mortality, and regular testing has a key role to play in both enabling access to early treatment and reducing onward transmission of HIV. Early diagnosis and subsequent treatment reduce an individual’s infectiousness and thus can have both individual and population level benefits. Regular testing is an important part of HIV prevention efforts, and emphasis has been placed not only on increasing overall rates of HIV testing, but frequency of testing. Increasing rates of HIV testing in populations most at risk of HIV is a key public health objective.
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Our findings suggest that interventions which seek to increase rates of HIV testing and testing frequency among young gay and bisexual men should include a specific focus on promoting and supporting positive testing practices within young men’s friendship groups and wider gay communities. Among young men who reported testing on an ad hoc basis, inconvenience and disruptions to HIV testing practices, particularly where men lacked social support, acted as a barrier to developing a routine of regular testing.
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Men who reported reactive testing practices described testing for HIV primarily in response to perceived exposure to sexual risk, along with ‘transitional moments’ such as starting, ending or changes to a relationship. Men with habitual testing practices framed HIV testing as both a personal and ‘community’ responsibility, and more effective than testing in response to risk events or emergent symptoms. The findings suggest that social support can play an important role in encouraging and facilitating HIV testing among young gay men, however, social norms of non-testing also have the potential to act as a barrier to development of a regular routine. This qualitative study, the first to explore patterns of HIV testing practices among young gay and bisexual men in the UK, contributes novel findings around the role of social support and ‘community’ in shaping young men’s approaches to HIV testing. Thematic analysis of men’s accounts of their approach to HIV testing identified three overarching patterns of testing: ‘habitual’, ‘reactive’ and ‘ ad hoc’. Qualitative interviews were conducted with thirty young gay and bisexual men (aged 18–29) in Scotland. Understanding HIV testing practices is important in the development of interventions to promote testing among young gay and bisexual men. In the UK, men who have sex with men (MSM) remain one of the communities most at risk of HIV and, within this, young gay men are a key risk group. Increasing overall rates, and frequency, of HIV testing in populations at risk is a key public health objective and a critical dimension of HIV prevention efforts.