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


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.

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Fig. 2


  1. 1.

    As we would expect given the nature of its measurement, the information avoidance scale was positively skewed. However, transforming the scale using a Log10 transformation (i.e., making the data normal) did not influence the pattern of results presented here.

  2. 2.

    We also ran the mediation models controlling for age, marital status, sexual orientation, employment, and outness given their significant associations with our outcomes. However, adding these variables to the model did not meaningfully change the reported outcomes. As such, we report the simpler model.


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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).

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Correspondence to Devon M. Price.

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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.

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Price, D.M., Howell, J.L., Gesselman, A.N. et al. Psychological threat avoidance as a barrier to HIV testing in gay/bisexual men. J Behav Med 42, 534–544 (2019).

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  • HIV testing
  • Decision making
  • Psychosocial barriers
  • Medical testing
  • MSM