AIDS and Behavior

, Volume 21, Issue 2, pp 561–575 | Cite as

HIV Testing Among Internet-Using MSM in the United States: Systematic Review

  • Meredith Noble
  • Amanda M. Jones
  • Kristina Bowles
  • Elizabeth A. DiNenno
  • Stephen J. Tregear
Substantive Review


Regular HIV testing enables early identification and treatment of HIV among at-risk men who have sex with men (MSM). Characterizing HIV testing needs for Internet-using MSM informs development of Internet-facilitated testing interventions. In this systematic review we analyze HIV testing patterns among Internet-using MSM in the United States who report, through participation in an online study or survey, their HIV status as negative or unknown and identify demographic or behavioral risk factors associated with testing. We systematically searched multiple electronic databases for relevant English-language articles published between January 1, 2005 and December 16, 2014. Using meta-analysis, we summarized the proportion of Internet-using MSM who had ever tested for HIV and the proportion who tested in the 12 months preceding participation in the online study or survey. We also identified factors predictive of these outcomes using meta-regression and narrative synthesis. Thirty-two studies that enrolled 83,186 MSM met our inclusion criteria. Among the studies reporting data for each outcome, 85 % (95 % CI 82–87 %) of participants had ever tested, and 58 % (95 % CI 53–63 %) had tested in the year preceding enrollment in the study, among those for whom those data were reported. Age over 30 years, at least a college education, use of drugs, and self-identification as being homosexual or gay were associated with ever having tested for HIV. A large majority of Internet-using MSM indicated they had been tested for HIV at some point in the past. A smaller proportion—but still a majority—reported they had been tested within the year preceding study or survey participation. MSM who self-identify as heterosexual or bisexual, are younger, or who use drugs (including non-injection drugs) may be less likely to have ever tested for HIV. The overall findings of our systematic review are encouraging; however, a subpopulation of MSM may benefit from targeted outreach. These findings indicate unmet needs for HIV testing among Internet-using MSM and identify subpopulations that might benefit from targeted outreach, such as provision of HIV self-testing kits.


Homosexuality Male Bisexuality HIV testing Internet Social media Systematic review Meta-analysis 



This work was funded by the Centers for Disease Control and Prevention under contract 200-2010-37417 awarded to MANILA Consulting Group, Inc.

Compliance with Ethical Standards

Conflict of Interest

None of the authors declare any potential conflicts of interest.


The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

10461_2016_1506_MOESM1_ESM.docx (47 kb)
Supplementary material 1 (DOCX 47 kb)


  1. 1.
    CDC, diagnoses of HIV infection in the United States and dependent areas, 2014. HIV surveillance report Accessed 26 May 2016
  2. 2.
    CDC, CDC Fact Sheet: HIV among gay and bisexual men. Accessed 26 May 2016
  3. 3.
    Sullivan PS, et al. Successes and challenges of HIV prevention in men who have sex with men. Lancet. 2012;380(9839):388–99.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Branson BM, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55(RR-14):1–17 quiz CE1–4.PubMedGoogle Scholar
  5. 5.
    Saxton P, Dickson N, Hughes A. Who is omitted from repeated offline HIV behavioural surveillance among MSM? Implications for interpreting trends. AIDS Behav. 2013;17(9):3133–44.CrossRefPubMedGoogle Scholar
  6. 6.
    Sanchez T, et al. Internet-based methods may reach higher-risk men who have sex with men not reached through venue-based sampling. Open AIDS J. 2012;6:83–9.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Icard LD. Reaching African-American men on the down low: sampling hidden populations: implications for HIV prevention. J Homosex. 2008;55(3):437–49.CrossRefPubMedGoogle Scholar
  8. 8.
    Rhodes SD, Bowie DA, Hergenrather KC. Collecting behavioural data using the world wide web: considerations for researchers. J Epidemiol Commun Health. 2003;57(1):68–73.CrossRefGoogle Scholar
  9. 9.
    Martinez O, et al. Still a hard-to-reach population? Using social media to recruit Latino gay couples for an HIV intervention adaptation study. J Med Internet Res. 2014;16(4):e113.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Chiasson MA, Hirshfield S, Rietmeijer C. HIV prevention and care in the digital age. J Acquir Immune Defic Syndr. 2010;55(Suppl 2):S94–7.CrossRefPubMedGoogle Scholar
  11. 11.
    EMIS 2010: The European Men-Who-Have-Sex-With-Men Internet Survey. Findings from 38 Countries. 2013; European Centre for Disease Prevention and Control.
  12. 12.
    Moher D, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    The Joanna Briggs Institute, Joanna Briggs Institute Reviewer’s Manual: 2011 edition. 2011: The Joanna Briggs Institute.Google Scholar
  14. 14.
    Raudenbush SJ. Analyzing effect sizes: random-effects models. In: Cooper H, Hedges LV, Valentine JC, editors. The handbook of research synthesis and meta-analysis. New York: The Russell Sage Foundation; 2009. p. 295–316.Google Scholar
  15. 15.
    Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.CrossRefPubMedGoogle Scholar
  16. 16.
    Shadish WR, Haddock CK. Combining estimates of effect sizes. In: Cooper H, Hedges LV, Valentine JC, editors. The handbook of research synthesis and meta-analysis. New York: Russell Sage Foundation; 2009. p. 257–77.Google Scholar
  17. 17.
    Harbord RM, Higgins, JPT. Meta-regression in Stata. Stata J, 2008; 8(4):493–519.
  18. 18.
    Laupacis A, Sekar N, Stiell IG. Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA. 1997;277(6):488–94.CrossRefPubMedGoogle Scholar
  19. 19.
    Peduzzi P, et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Treadwell JR, et al. A system for rating the stability and strength of medical evidence. BMC Med Res Methodol. 2006;6:52.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Guyatt GH, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Atkins D, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490.CrossRefPubMedGoogle Scholar
  23. 23.
    Akin M, et al. HIV risk behaviors of Latin American and Caribbean men who have sex with men in Miami, Florida, USA. Rev Panam Salud Publica. 2008;23(5):341–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Sullivan PS, et al. Bias in online recruitment and retention of racial and ethnic minority men who have sex with men. J Med Internet Res. 2011;13(2):e38.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Rhodes SD, Hergenrather KC, Duncan J, Vissman AT, Miller C, Wilkin AM, Stowers J, Eng E. A pilot intervention utilizing Internet chat rooms to prevent HIV risk behaviors among men who have sex with men. Public Health Rep. 2010;125(Suppl 1):29–37.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Dew BJ, Chaney MP. The relationship among sexual compulsivity, internalized homophobia, and HIV at-risk sexual behavior in gay and bisexual male users of internet chat rooms. Sex Addict Compuls. 2005;12(4):259–73.CrossRefGoogle Scholar
  27. 27.
    Fernandez MI, et al. Cruising in cyber space: comparing Internet chat room versus community venues for recruiting Hispanic men who have sex with men to participate in prevention studies. J Ethn Subst Abuse. 2007;6(2):143–62.CrossRefPubMedGoogle Scholar
  28. 28.
    Balan IC, et al. Are HIV-negative men who have sex with men and who bareback concerned about HIV infection? Implications for HIV risk reduction interventions. Arch Sex Behav. 2013;42(2):279–89.CrossRefPubMedGoogle Scholar
  29. 29.
    Grov C, et al. Exploring the venue’s role in risky sexual behavior among gay and bisexual men: an event-level analysis from a national online survey in the U.S. Arch Sex Behav. 2013;42(2):291–302.CrossRefPubMedGoogle Scholar
  30. 30.
    Kubicek K, et al. Use and perceptions of the internet for sexual information and partners: a study of young men who have sex with men. Arch Sex Behav. 2011;40(4):803–16.CrossRefPubMedGoogle Scholar
  31. 31.
    Chiasson MAS, Shaw FS, Humberstone M, Hirshfield S, Hartel D. Increased HIV disclosure 3 months after an online video intervention for men who have sex with men (MSM). AIDS Care. 2009;21(9):1081–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Margolis ADJ, Joseph H, Belcher L, Hirshfield S, Chiasson MA. ‘Never testing for HIV’ among men who have sex with men recruited from a sexual networking website, United States. AIDS Behav. 2012;16(1):23–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Horvath KJ, Bowen AM, Williams ML. Virtual and physical venues as contexts for HIV risk among rural men who have sex with men. Health Psychol. 2006;25(2):237–42.CrossRefPubMedGoogle Scholar
  34. 34.
    Horvath KJ, Oakes JM, Rosser BR. Sexual negotiation and HIV serodisclosure among men who have sex with men with their online and offline partners. J Urban Health. 2008;85(5):744–58.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Horvath KJ, Weinmeyer R, Rosser S. Should it be illegal for HIV-positive persons to have unprotected sex without disclosure? An examination of attitudes among US men who have sex with men and the impact of state law. AIDS Care. 2010;22(10):1221–8.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Horvath KJ, Beadnell B, Bowen AM. Sensation seeking as a moderator of Internet use on sexual risk taking among men who have sex with men. Sex Res Soc Policy. 2006;3(4):77–90.CrossRefGoogle Scholar
  37. 37.
    Jozkowski K, et al. Relations between circumcision status, sexually transmitted infection history, and HIV serostatus among a national sample of men who have sex with men in the United States. AIDS Patient Care STDS. 2010;24(8):465–70.CrossRefPubMedGoogle Scholar
  38. 38.
    Khosropour CM, Johnson BA, Ricca AV, Sullivan PS. Enhancing retention of an Internet-based cohort study of men who have sex with men (MSM) via text messaging: randomized controlled trial. J Med Internet Res. 2013;15(8):e194.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Wagenaar BH, et al. Do Men who have Sex with Men (MSM) in the United States understand that HIV Serodiscordance is possible? Open AIDS J. 2013;7:14–6.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Wilkerson JM, Smolenski DJ, Horvath KJ, Danilenko GP, Rosser BRS. Online and offline sexual health-seeking patterns of HIV-negative men who have sex with men. AIDS Behav. 2010;14(6):1362–70.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Rosser BR, Miner MH, Bockting WO, Ross MW, Konstan J, Gurak L, Stanton J, Edwards W, Jacoby S, Carballo-Dieguez A, Mazin R, Coleman E. HIV risk and the internet: results of the Men’s INTernet Sex (MINTS) Study. AIDS Behav. 2009;13(4):746–56.CrossRefPubMedGoogle Scholar
  42. 42.
    Mustanski BS. Are sexual partners met online associated with HIV/STI risk behaviours? Retrospective and daily diary data in conflict. AIDS Care. 2007;19(6):822–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Wagenaar BH, Christiansen-Lindquist L, Khosropour C, Salazar LF, Benbow N, Prachand N, Sineath RC, Stephenson R, Sullivan PS. Willingness of US men who have sex with men (MSM) to participate in Couples HIV Voluntary Counseling and Testing (CVCT). PLoS One. 2012;7(8):e42953.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Grov C, et al. Exploring the internet’s role in sexual compulsivity and out of control sexual thoughts/behaviour: a qualitative study of gay and bisexual men in New York City. Cult Health Sex. 2008;10(2):107–25.CrossRefPubMedGoogle Scholar
  45. 45.
    Rendina HJ, Jimenez RH, Grov C, Ventuneac A, Parsons JT. Patterns of lifetime and recent HIV testing among men who have sex with men in New York City who use Grindr. AIDS Behav. 2013;18(1):41–9.CrossRefGoogle Scholar
  46. 46.
    Rucinski K, et al. Knowledge and use of pre-exposure prophylaxis among an online sample of young men who have sex with men in New York City. AIDS Behav. 2013;17(6):2180–4.CrossRefPubMedGoogle Scholar
  47. 47.
    Schnarrs PW, Rosenberger JG, Schick VR, Novak DS, Herbenick D, Reece M. Gay and bisexual Latino men’s sexual health and behaviors: a national online sample. Int J Men’s Health. 2012;11(1):22–35.CrossRefGoogle Scholar
  48. 48.
    Stephenson R, Khosropour C, Sullivan P. Reporting of intimate partner violence among men who have sex with men in an online survey. West J Emerg Med. 2010;11(3):242–6.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Stephenson R, et al. Willingness to use couples voluntary counseling and testing services among men who have sex with men in seven countries. AIDS Care. 2013;26(2):191–8.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Wagenaar BH, Sullivan PS, Stephenson R. HIV knowledge and associated factors among internet-using men who have sex with men (MSM) in South Africa and the United States. PLoS One. 2012;7(3):e32915.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Wall KM, Khosropour CM, Sullivan PS. Offering of HIV screening to men who have sex with men by their health care providers and associated factors. J Int Assoc Phys AIDS Care (Chic). 2010;9(5):284–8.CrossRefGoogle Scholar
  52. 52.
    Welles S, Ross M, Banik S, Fisher L, McFarlane M, Kachur R, Rietmeijer C, Allensworth-Davies D. Demographic and sexual behavior comparisons of Indian and U.S. Internet samples of men who have sex with men. Int J Sex Health. 2011;23(2):90–101.CrossRefGoogle Scholar
  53. 53.
    Navejas, M. Sexual risk among men who have sex with men with online sex partners in New York city: Insight using the centers for disease control and prevention’s Web-Based HIV Behavioral Surveillance and national HIV Behavioral Surveillance. 2013, ProQuest Information & Learning: US.Google Scholar
  54. 54.
    Navejas MN, Neaigus A, Torian L, Murrill C. Participation in online and offline HIV prevention among men who have sex with men who use the internet to meet sex partners in New York City. AIDS Behav. 2012;16(2):389–95.CrossRefPubMedGoogle Scholar
  55. 55.
    Raymond HF, et al. Comparing internet-based and venue-based methods to sample MSM in the San Francisco bay area. AIDS Behav. 2010;14(1):218–24.CrossRefPubMedGoogle Scholar
  56. 56.
    Ryan, CL, Bauman, K. Educational Attainment in the United States: 2015. 2016: U.S. Census Bureau.
  57. 57.
    USPHS, United States Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States—2014 clinical practice guideline. 2014.
  58. 58.
    Mustanski B, Garofalo R, Monahan C, Gratzer B, Andrews R. Feasibility, acceptability, and preliminary efficacy of an online HIV prevention program for diverse young men who have sex with men: the keep it up! intervention. AIDS Behav. 2013;17(9):2999–3012.CrossRefPubMedGoogle Scholar
  59. 59.
    CDC, Men Who Have Sex With Men—National HIV Behavioral Surveillance, 20 U.S. Cities, 2014. HIV Surveillance Special Report 15. Accessed 22 June 2016.
  60. 60.
    Kwan CK, Rose, CE, Brooks JT, Marks G, Sionean C., HIV Testing Among Men at Risk for Acquiring HIV Infection Before and After the 2006 CDC Recommendations. Accessed 26 May 2016; 131: p. 311–319.
  61. 61.
    Reilly KH, Neaigus A, Jenness SM, Wendel T, Marshall DM 4th, Hagan H. Factors associated with recent HIV testing among men who have sex with men in New York City. AIDS Behav. 2014;18(Suppl 3):297–304.CrossRefPubMedGoogle Scholar
  62. 62.
    Conway DP, Holt M, Couldwell DL, Smith DE, Davies SC, McNulty A, Keen P, Cunningham P, Guy R. Barriers to HIV testing and characteristics associated with never testing among gay and bisexual men attending sexual health clinics in Sydney. J Int AIDS Soc. 2015;18:20221.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Lauby JL, Milnamow M. Where MSM have their first HIV test: differences by race, income, and sexual identity. Am J Mens Health. 2009;3(1):50–9.CrossRefPubMedGoogle Scholar
  64. 64.
    Pathela P, Hajat A, Schillinger J, Blank S, Sell R, Mostashari F. Discordance between sexual behaviour and self-reported sexual identity: a population-based survey of New York City men. Ann Intern Med. 2006;146(6):416–25.CrossRefGoogle Scholar
  65. 65.
    Van Handel M, Lyons B, Oraka E, Nasrullah M, DiNenno E, Dietz P. Factors associated with time Since last HIV test among persons at high risk for HIV infection, National Survey of Family Growth, 2006–2010. AIDS Patient Care STDS. 2015;29(10):533–40.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Blas MM, AlvaI, Carcamo CP, Cabello R, Goodreau SM, Kimball AM, Kurth AE. Effect of an online video-based intervention to increase HIV testing in men who have sex with men in Peru. PLoS One. 2010; 5(5): e10448.
  67. 67.
    Sullivan PS, Khosropour CM, Luisi N, Amsden M, Coggia T, Wingood GM, DiClemente RJ. Bias in online recruitment and retention of racial and ethnic minority men who have sex with men. J Med Internet Res. 2011;13:e38.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    CDC, CDC Fact Sheet. HIV Among Youth. Accessed 24 June 2016.
  69. 69.
    Balaji AB, Bowles KE, Le BC, Paz-Bailey G, Oster AM. High HIV incidence and prevalence and associated factors among young MSM, 2008. AIDS. 2008;27(2):269–78.CrossRefGoogle Scholar
  70. 70.
    Mustanski B, Lyons T, Garcia SC. Internet use and sexual health of young men who have sex with men: a mixed-methods study. Accessed 24 June 2016. Arch Sex Behav, 2010.
  71. 71.
    National Alliance of State and Territorial AIDS Directors. Reaching them where they are: a guide for using online and social media to conduct sexual health outreach with youth. Accessed 24 June 2016. 2012.
  72. 72.
    Chiu CJ, Young SD. Correlates of requesting home HIV self-testing kits on online social networks among African-American and Latino men who have sex with men. AIDS Care. 2016;28(3):389–93.CrossRefGoogle Scholar
  73. 73.
    Elliot E, Rossi M, McCormack S, McOwan A. Identifying undiagnosed HIV in men who have sex with men (MSM) by offering HIV home sampling via online gay social media: a service evaluation. Sex Transm Infect, 2016. ePub ahead of print.Google Scholar
  74. 74.
    Grov C, Cain D, Whitfield TH, Rendina HJ, Pawsob M, Ventuneac A, Parsons JT. Recruiting a U.S. national sample of HIV-negative gay and bisexual men to complete at-home self-administered HIV/STI testing and surveys: challenges and Opportunities. Sex Res Soc Policy. 2016;13(1):1–21.CrossRefGoogle Scholar
  75. 75.
    Chavez RP, M.R, Wesolowski LG, Freeman A, Higa DH, Raiford J, Johnson WD, Margolis A, Belcher L, Ethridge S, Borkowf CB, Owen SM, McNaughten AD, Branson BM, Evaluation of rapid HIV self-testing among men who have sex with men (MSM) in high prevalence cities: the eSTAMP Project. Poster Presentation at 2015 HIV diagnostics conference. Atlanta GA March 21-24, 2016.

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Meredith Noble
    • 1
  • Amanda M. Jones
    • 2
  • Kristina Bowles
    • 3
  • Elizabeth A. DiNenno
    • 3
  • Stephen J. Tregear
    • 4
  1. 1.Hayes, Inc.LansdaleUSA
  2. 2.MANILA Consulting GroupMcleanUSA
  3. 3.Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAtlantaUSA
  4. 4.Civil Health GroupBooz Allen HamiltonWashington, D.C.USA

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