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

Abstract

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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

Notes

  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.

References

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bollen, K. A. (1989). Structural equations with latent variables. New York, NY: Wiley.

    Google 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.

    Article  CAS  PubMed  Google Scholar 

  4. Boomsma, A. (1985). Nonconvergence, improper solutions, and starting values in LISREL maximum likelihood estimation. Psychometrika, 50, 229–242.

    Article  Google 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 http://www.cdc.gov/hiv/pdf/dhap_continuum.pdf.

  7. Centers for Disease Control and Prevention. (2015a). Georgia 2015 state health profile. Retrieved from http://www.cdc.gov/nchhstp/stateprofiles/pdf/Georgia_profile.pdf.

  8. Centers for Disease Control and Prevention. (2015b). State HIV prevention progress report, 20102013. Retrieved from http://www.cdc.gov/hiv/pdf/policies/progressreports/cdc-hiv-stateprogressreport.pdf.

  9. Centers for Disease Control and Prevention. (2016a). CDC FY 2017 budget request summary domestic HIV prevention. Retrieved from https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-budget-summary.pdf.

  10. Centers for Disease Control and Prevention. (2016b). Prevalence of diagnosed and undiagnosed HIV infectionUnited States, 20082012 (MMWR No. 64) (pp. 657–662).

  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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Howell, J. L., Ratliff, K. A., & Shepperd, J. A. (2016). Automatic attitudes and health information avoidance. Health Psychology, 35(8), 816–823.

    Article  PubMed  Google Scholar 

  15. Howell, J. L., & Shepperd, J. A. (2012). Reducing information avoidance through affirmation. Psychological Science, 23, 141–145.

    Article  PubMed  Google Scholar 

  16. Howell, J. L., & Shepperd, J. A. (2013). Reducing health-information avoidance through contemplation. Psychological Science, 24, 1696–1703.

    Article  PubMed  Google Scholar 

  17. Howell, J. L., & Shepperd, J. A. (2016). Establishing an information avoidance scale. Psychological Assessment, 28, 1695.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  CAS  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  22. Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12, 23–44. https://doi.org/10.1037/1082-989X.12.1.23

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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.

  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. https://doi.org/10.1037/a0021288

    Article  Google Scholar 

  30. Sweeny, K., & Miller, W. (2012). Predictors of information avoidance: When does ignorance seem most blissful? Self and Identity, 11, 185–201.

    Article  Google 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.

    Article  PubMed  Google Scholar 

  32. Varga, C. A. (2001). Coping with HIV/AIDS in Durban’s commercial sex industry. AIDS Care, 13, 351–365. https://doi.org/10.1080/09540120120044008

    Article  CAS  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  Google Scholar 

Download references

Acknowledgements

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.

Funding

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

Author information

Affiliations

Authors

Corresponding author

Correspondence to Devon M. Price.

Ethics declarations

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1007/s10865-018-0003-z

Download citation

Keywords

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