Gay, bisexual men complacent about HIV testing, study finds

Survey results released Thursday suggest a troubling complacency toward HIV among gay and bisexual men in the United States that public health experts say could undermine efforts to slow down or even stop the spread of the disease.

Fewer than 20 percent of gay and bisexual men have been tested for HIV in the previous six months — as recommended by national public health agencies — and nearly a third have never been tested at all, according to a survey conducted in the summer by the Kaiser Family Foundation. The same survey found that gay and bisexual men were largely uninformed about drug therapies to prevent HIV and that most of them rarely, if ever, talk to their doctors about the virus.

The results are frustrating to HIV experts and gay advocacy groups because they come at a time when treatment and prevention therapies abound, but nationwide rates of new HIV diagnoses continue to climb among gay and bisexual men. Halting HIV requires individuals be aware of their HIV status and health care options — something that the findings suggest isn’t happening.

“HIV has kind of faded into the background in the lives of many gay and bisexual men,” said Richard Wolitski, senior adviser in the Division of HIV/AIDS Prevention for the U.S. Centers for Disease Control and Prevention. “It underscores how important it is that health care providers and community-based organizations make sure that they’re continuing to remind gay and bisexual men of the impact of HIV on the community. And that we continue to talk about the virus.”

The Kaiser survey involved 431 men across the country, and it’s impossible to say how well the results apply to any one city. Gay and bisexual men in San Francisco almost definitely are more aware of HIV treatment and prevention options than men in other parts of the country, said local and national public health experts.

San Francisco is one of the few cities where rates of new HIV diagnoses are falling among men who have sex with men. There were 359 new HIV diagnoses in San Francisco last year, down from 426 in 2012. Those diagnoses were among all people in San Francisco, but men who have sex with men account for more than 85 percent of cases.

Nationwide, new HIV diagnoses among gay and bisexual men increased 12 percent from 2008 to 2010, the most recent year available, according to the CDC. New diagnoses rose 22 percent among men under age 25.

“HIV has remained on the mind of the city and community here, since the beginning of the epidemic,” said Dr. Susan Philip, director of Disease Prevention and Control in the San Francisco public health department. “We have a relatively good situation compared to what’s happening nationally. What we need to realize is we can’t become too complacent. We can’t back off.”

Gay and bisexual men are “knocking down doors” to get HIV tests at Magnet, the health clinic run by the San Francisco AIDS Foundation in the Castro, said Pierre-Cedric Crouch, director of nursing. But even in San Francisco, there are barriers to getting tested, he said.

People might not realize they’re at risk of HIV, for example. They might think they’re only having sex with people who are HIV-negative, even if their partners also aren’t getting tested regularly. Other people may not know where to go to get tested, or they may falsely believe that they’ve taken an HIV test during a regular doctor’s visit.

Still, Philip and Crouch noted that men in San Francisco are much more likely to know their HIV status than men in other parts of the country. About 8 percent of gay and bisexual men in San Francisco who are HIV-positive don’t know it, compared to 18 percent nationwide, according to the CDC.

That’s important because multiple studies have shown that early treatment of HIV is critical to both the individual’s long-term health and a reduction in spread of disease. People who start taking antiretroviral drugs soon after diagnosis can reduce the amount of virus in their blood to undetectable levels, which research has shown can cut to nearly zero their chances of passing on HIV to someone else.

But the Kaiser Family Foundation study found that not only were many men across the rest of the nation not getting tested for HIV nearly often enough, they also didn’t know how effective antiretroviral treatment is, for both health and prevention. Fewer than half of those surveyed said they were aware that drug therapy should start immediately after diagnosis, and only about 25 percent said they knew that treatment could prevent spread of disease.

Also, only about 25 percent of men surveyed said they knew about pre-exposure prophylaxis, or PrEP, which is an antiretroviral drug that can be given to uninfected people to protect them from the virus.

“There are some significant gaps in awareness. And that matters in terms of people understanding their risk of getting HIV,” said Liz Hamel, director of public opinion and survey research for the Kaiser Family Foundation.

The irony, Hamel added, is that a large proportion of men — 75 percent — said they recognize that people not knowing their HIV status is a major cause of continued spread of disease, even as they admit they don’t get tested as often as they should.

The Kaiser survey found some striking differences in attitudes and awareness among different age and ethnic groups. Gay and bisexual minority men were much more concerned about becoming infected with HIV than white men — 53 percent compared to 28 percent.

Not surprisingly, older men were much more likely than men under age 35 to have been personally affected by HIV. More than half of older men said they knew someone with HIV and 47 percent said someone close them had died of HIV.

“We get a sense that a lot of younger gay men don’t see this as an issue that is personally impacting them,” Hamel said. “More than half say they’re not personally concerned about getting infected. … There’s a sense of ‘It’s not an issue that I need to take action on personally.’”

That’s an attitude that can’t continue, said HIV and patient advocacy experts.

“We have really effective ways for people to protect themselves. We have more to offer people now than ever before,” Philip said. “We need innovative ways we can continue to engage people and have them not being fatigued by this issue.”

Erin Allday is a San Francisco Chronicle staff writer. E-mail: eallday@sfchronicle.com Twitter: @erinallday

Gay, bisexual men complacent about HIV testing, study finds