Journal of Behavioral Medicine

, Volume 42, Issue 3, pp 534–544 | Cite as

Psychological threat avoidance as a barrier to HIV testing in gay/bisexual men

  • Devon M. PriceEmail author
  • Jennifer L. Howell
  • Amanda N. Gesselman
  • Stephanie Finneran
  • Diane M. Quinn
  • Lisa A. Eaton


The present study examined how three psychosocial barriers—anticipated HIV stigma, HIV infectiousness-reduction beliefs, and optimism about available HIV treatments—related to HIV testing history and acceptance of an at-home HIV test among men who have sex with men. We also examined the mediating role of a variable that affects medical screening for other health conditions but has not yet been investigated in HIV contexts: the tendency to avoid psychologically threatening information. Volunteers completed a paper and pencil survey and were offered a free at-home HIV test during the 2015 Atlanta Pride Festival in Atlanta, GA. Anticipated HIV stigma, infectiousness beliefs, and treatment optimism were inconsistently related to HIV testing history and acceptance of an at-home HIV test, but all had direct effects on the desire to avoid HIV information. In a mediation model, each of these psychosocial barriers had indirect effects on both HIV testing outcomes via information avoidance. These findings suggest that information avoidance is an important proximal HIV testing barrier, thus providing a novel target for interventions and information campaigns.


HIV testing Decision making Psychosocial barriers Medical testing MSM 



We thank Seth Kalichman for his unwavering support of this project. Without the generous amount of resources he provided, this study would not have been feasible.


This study was funded by the NIMH T-32 HIV training Grant (5629880).

Compliance with ethical standards

Conflict of interest

Devon M. Price, Jennifer L. Howell, Amanda N. Gesselman, Stephanie Finneran, Diane M. Quinn and Lisa A. Eaton declare that they have no conflict of interest.

Human and animal rights and informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


  1. Albarracín, D., Durantini, M. R., Earl, A., Gunnoe, J. B., & Leeper, J. (2008). Beyond the most willing audiences: A meta-intervention to increase exposure to HIV-prevention programs by vulnerable populations. Health Psychology, 27, 638.CrossRefGoogle Scholar
  2. Bollen, K. A. (1989). Structural equations with latent variables. New York, NY: Wiley.CrossRefGoogle Scholar
  3. Bolsewicz, K., Vallely, A., Debattista, J., Whittaker, A., & Fitzgerald, L. (2015). Factors impacting HIV testing: A review—Perspectives from Australia, Canada, and the UK. AIDS Care, 27, 570–580.CrossRefGoogle Scholar
  4. Boomsma, A. (1985). Nonconvergence, improper solutions, and starting values in LISREL maximum likelihood estimation. Psychometrika, 50, 229–242.CrossRefGoogle Scholar
  5. Centers for Disease Control and Prevention. (2014a). HIV risk, prevention, and testing behaviors: National HIV Behavioral Surveillance System: Men who have sex with men, 20 US Cities, 2011. HIV Surveillance Special Report, 8, 1–40.Google Scholar
  6. Centers for Disease Control and Prevention. (2014b). Understanding the HIV care continuum. Retrieved June 2016 from
  7. Centers for Disease Control and Prevention. (2015a). Georgia 2015 state health profile. Retrieved from
  8. Centers for Disease Control and Prevention. (2015b). State HIV prevention progress report, 20102013. Retrieved from
  9. Centers for Disease Control and Prevention. (2016a). CDC FY 2017 budget request summary domestic HIV prevention. Retrieved from
  10. Centers for Disease Control and Prevention. (2016b). Prevalence of diagnosed and undiagnosed HIV infectionUnited States, 20082012 (MMWR No. 64) (pp. 657–662).Google Scholar
  11. Dowson, L., Kober, C., Perry, N., Fisher, M., & Richardson, D. (2012). Why some MSM present late for HIV testing: A qualitative analysis. AIDS Care, 24, 204–209.CrossRefGoogle Scholar
  12. Dwyer, L. A., Shepperd, J. A., & Stock, M. L. (2015). Predicting avoidance of skin damage feedback among college students. Annals of Behavioral Medicine, 49(5), 685–695.CrossRefGoogle Scholar
  13. Earnshaw, V. A., Smith, L. R., Chaudoir, S. R., Amico, K. R., & Copenhaver, M. M. (2013). HIV stigma mechanisms and well-being among PLWH: A test of the HIV stigma framework. AIDS and Behavior, 17, 1785–1795.CrossRefGoogle Scholar
  14. Howell, J. L., Ratliff, K. A., & Shepperd, J. A. (2016). Automatic attitudes and health information avoidance. Health Psychology, 35(8), 816–823.CrossRefGoogle Scholar
  15. Howell, J. L., & Shepperd, J. A. (2012). Reducing information avoidance through affirmation. Psychological Science, 23, 141–145.CrossRefGoogle Scholar
  16. Howell, J. L., & Shepperd, J. A. (2013). Reducing health-information avoidance through contemplation. Psychological Science, 24, 1696–1703.CrossRefGoogle Scholar
  17. Howell, J. L., & Shepperd, J. A. (2016). Establishing an information avoidance scale. Psychological Assessment, 28, 1695.CrossRefGoogle Scholar
  18. Kalichman, S. C., Eaton, L., White, D., Cherry, C., Pope, H., Cain, D., et al. (2007). Beliefs about treatments for HIV/AIDS and sexual risk behaviors among men who have sex with men, 1997–2006. Journal of Behavioral Medicine, 30, 497–503.CrossRefGoogle Scholar
  19. Kalichman, S. C., & Simbayi, L. C. (2003). HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa. Sexually Transmitted Infections, 79, 442–447.CrossRefGoogle Scholar
  20. Lekalakala-Mokgele, E. (2014). Understanding of the risk of HIV infection among the elderly in Ga-Rankuwa, South Africa. SAHARA-J: Journal of Social Aspects of HIV/AIDS, 11, 67–75.CrossRefGoogle Scholar
  21. Lorenc, T., Marrero-Guillamón, I., Llewellyn, A., Aggleton, P., Cooper, C., Lehmann, A., et al. (2011). HIV testing among men who have sex with men (MSM): Systematic review of qualitative evidence. Health Education Research, 26(5), 834–846.CrossRefGoogle Scholar
  22. Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12, 23–44. CrossRefGoogle Scholar
  23. Nunn, A., Eng, W., Cornwall, A., Beckwith, C., Dickman, S., Flanigan, T., et al. (2012). African American patient experiences with a rapid HIV testing program in an urban public clinic. Journal of the National Medical Association, 104, 5–13.CrossRefGoogle Scholar
  24. Nunnally, J. C. (1967). Psychometric theory. New York, NY: McGraw-Hill.Google Scholar
  25. Prati, G., Mazzoni, D., & Zani, B. (2015). Psychosocial predictors and HIV-related behaviors of old adults versus late middle-aged and younger adults. Journal of Aging and Health, 27, 123–139.CrossRefGoogle Scholar
  26. Price, D. M., Gesselman, A. N., & Garcia, J. (under review). Bisexual men’s and women’s perceptions of acceptance in the LGBTQ community: Evidence from a 2016 National U.S. Sample.Google Scholar
  27. Shepperd, J. A., & Howell, J. L. (2015). Responding to psychological threats with deliberate ignorance: Causes and remedies. In P. J. Carroll, R. M. Arkin, & A. Wichman (Eds.), Handbook of personal security. New York, NY: Taylor & Francis.Google Scholar
  28. Steele, C. M. (1988). The psychology of self-affirmation: Sustaining the integrity of the self. Advances in Experimental Social Psychology, 21, 261–302.Google Scholar
  29. Sweeny, K., Melnyk, D., Miller, W. A., & Shepperd, J. A. (2010). Information avoidance: Who, what, when, and why. Review of General Psychology, 14, 340–353. CrossRefGoogle Scholar
  30. Sweeny, K., & Miller, W. (2012). Predictors of information avoidance: When does ignorance seem most blissful? Self and Identity, 11, 185–201.CrossRefGoogle Scholar
  31. van Koningsbruggen, G. M., & Das, E. (2009). Don’t derogate this message! Self-affirmation promotes online type 2 diabetes risk test taking. Psychology and Health, 24, 635–649.CrossRefGoogle Scholar
  32. Varga, C. A. (2001). Coping with HIV/AIDS in Durban’s commercial sex industry. AIDS Care, 13, 351–365. CrossRefGoogle Scholar
  33. Wallace, S. A., McLellan-Lemal, E., Harris, M. J., Townsend, T. G., & Miller, K. S. (2011). Why take an HIV test? Concerns, benefits, and strategies to promote HIV testing among low-income heterosexual African American young adults. Health Education and Behavior, 38, 462–470.CrossRefGoogle Scholar
  34. Wolf, E. J., Harrington, K. M., Clark, S. L., & Miller, M. W. (2013). Sample size requirements for structural equation models: An evaluation of power, bias, and solution propriety. Educational and Psychological Measurement, 73, 913–934.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Devon M. Price
    • 1
    Email author
  • Jennifer L. Howell
    • 2
  • Amanda N. Gesselman
    • 3
  • Stephanie Finneran
    • 4
  • Diane M. Quinn
    • 4
  • Lisa A. Eaton
    • 4
  1. 1.Hunter HIV/AIDS Research TeamHunter CollegeNew YorkUSA
  2. 2.Department of Psychological SciencesUniversity of CaliforniaMercedUSA
  3. 3.Kinsey InstituteIndiana UniversityBloomingtonUSA
  4. 4.Department of Psychological SciencesUniversity of ConnecticutStorrsUSA

Personalised recommendations