AIDS and Behavior

, Volume 20, Issue 9, pp 1989–1999 | Cite as

How Different are Men Who Do Not Know Their HIV Status from Those Who Do? Results from an U.S. Online Study of Gay and Bisexual Men

  • Christian Grov
  • H. Jonathon Rendina
  • Jeffrey T. ParsonsEmail author
Original Paper


We compared self-described HIV-positive (31.6 %, n = 445), HIV-negative (56.8 %, n = 801), and HIV-unknown (11.6 %, n = 164) gay and bisexual men on sociodemographic and behavioral characteristics. Participants from across the U.S. were enrolled via a popular sexual networking website to complete an online survey. In total, 44.8 % of HIV-negative and HIV-unknown men said they had not been tested for HIV in the CDC-recommended last 6 months. HIV-unknown men significantly differed from HIV-negative and HIV-positive men in sexual behavior and HIV status disclosure patterns. HIV-unknown men were more willing than HIV-negative men to take PrEP; however, HIV-unknown men were significantly less likely than others to have health insurance or a primary care provider. Given the observed differences, researchers should consider analyzing men who are HIV-unknown distinctly from HIV-negative and HIV-positive men.


HIV testing Men who have sex with men Gay and bisexual men Condomless anal sex HIV status disclosure 


Comparamos hombres auto-descritos como gay y bisexuales (GBM), VIH-positivo (31.6 %, n = 445), VIH-negativo (56.8 %, n = 801), y VIH-desconocido (11.6 %, n = 164) en características sociodemográficas y conductuales. Participantes de todo los EE.UU. fueron inscritos a través de un sitio web popular de redes sexuales para completar una encuesta en línea. En total, el 44.8 % de los hombres VIH-negativo y VIH-desconocido reportaron no haberse realizado la prueba para detectar el VIH dentro de los últimos 6 meses recomendados por el CDC. Hombres VIH-desconocido difirieron significativamente de hombres VIH-negativo y VIH-positivo en comportamiento sexual y patrones de revelación de su estado de VIH. Hombres VIH-desconocido estuvieron más dispuestos a tomar PrEP que hombres VIH-negativo; sin embargo, hombres VIH-desconocido fueron significativamente menos propensos a tener un seguro médico o proveedor de atención primaria. Dadas las diferencias observadas, los investigadores deben considerar analizar los hombres VIH-desconocido de un modo distinto de los hombres VIH-negativo y VIH-positivo.



Data for this study were gathered in concert with online recruitment efforts to identify and screen potential participants to enroll in one of the following studies conducted at the Hunter College Center for HIV/AIDS Educational Studies and Training (CHEST): Express Yourself (R03DA033868—Brooke Wells, Principal Investigator), Keep it Up (R01 DA035145– Brian Mustanski, Principal Investigator) and WISE (R01 DA029567—Jeffrey T. Parsons, Principal Investigator). Jonathon Rendina was supported by a career development award from the National Institute on Drug Abuse (K01-DA039030). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to thank Ruben Jimenez for his valuable assistance with the projects, as well as other members of the CHEST Team: Chris Murphy, Ana Ventuneac, Demetria Cain, Carlos Ponton, Chris Hietikko, and Tyrel Starks.

Compliance with Ethical Standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Research involving human subjects

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    CDC. HIV in the United States: at a glance. 2015. Accessed 22 July 2015.
  2. 2.
    CDC. HIV among gay and bisexual men. 2015. Accessed 1 June 2015.
  3. 3.
    CDC. HIV prevention in the United States: expanding the impact. 2013. Accessed 11 August 2015.
  4. 4.
    CDC. HIV surveillance: men who have sex with men (MSM). 2015. Accessed 23 July 2015.
  5. 5.
    CDC. HIV among African American gay and bisexual men. 2014.
  6. 6.
    CDC. Prevalence and awareness of HIV infection among men who have sex with men: 21 cities, United States, 2008. Morb Mortal Wkly Rep. 2010;59(37):1207.Google Scholar
  7. 7.
    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. 2014;18:41–9.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    New York City Department of Health and Mental Hygiene. Epiquery: NYC interactive health data system (community health survey 2011). 2013. Accessed 13 March 2013.
  9. 9.
    Millett GA, Ding H, Marks G, et al. Mistaken assumptions and missed opportunities: correlates of undiagnosed HIV infection among Black and Latino men who have sex with men. J Acquir Immune Defic Syndr. 2011;58(1):64–71.CrossRefPubMedGoogle Scholar
  10. 10.
    CDC. HIV risk, prevention, and testing behaviors among men who have sex with men: National HIV Behavioral Surveillance System, 21 U.S. cities, United States, 2008. Morb Mort Wkly Rep. 2011;60(SS14 (SS-14):):1–34.Google Scholar
  11. 11.
    Paz-Bailey G, Hall HI, Wolitski RJ, et al. HIV testing and risk behaviors among gay, bisexual, and other men who have sex with men: United States. Morb Mortal Wkly Rep. 2013;62(47):958–62.Google Scholar
  12. 12.
    Das M, Chu PL, Santos GM, et al. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PLoS One. 2010;5(6):e11068.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Steward WT, Remien RH, Higgins JA, et al. Behavior change following diagnosis with acute/early HIV infection: a move to serosorting with other HIV-infected individuals. The NIMH Multisite Acute HIV Infection Study: III. AIDS Behav. 2009;13(6):1054–60.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Marks G, Millett GA, Bingham T, Lauby J, Murrill CS, Stueve A. Prevalence and protective value of serosorting and strategic positioning among Black and Latino men who have sex with men. Sex Transm Dis. 2010;37:325–7.PubMedGoogle Scholar
  15. 15.
    Van de Ven P, Kippax S, Crawford J, et al. In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care. 2002;14(4):471–80.CrossRefPubMedGoogle Scholar
  16. 16.
    Dubois-Arber F, Jeannin A, Lociciro S, Balthasar H. Risk reduction practices in men who have sex with men in Switzerland: serosorting, strategic positioning, and withdrawal before ejaculation. Arch Sex Behav. 2011;41:1263–72.CrossRefPubMedGoogle Scholar
  17. 17.
    Tieu HV, Li X, Donnell D, et al. Anal sex role segregation and versatility among men who have sex with men: EXPLORE study. J Acquir Immune Defic Syndr. 2013;64(1):121–5.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Parsons JT, Schrimshaw EW, Bimbi DS, Wolitski RJ, Gomez CA, Halkitis PN. Consistent, inconsistent, and non-disclosure to casual sexual partners among HIV-seropositive gay and bisexual men. AIDS. 2005;19(1):S87–97.CrossRefPubMedGoogle Scholar
  19. 19.
    Cassels S, Katz DA. Seroadaptation among men who have sex with men: emerging research themes. Curr HIV/AIDS Rep. 2013;10(4):305–13.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    McFarland W, Chen YH, Nguyen B, et al. Behavior, intention or chance? A longitudinal study of HIV seroadaptive behaviors, abstinence and condom use. AIDS Behav. 2012;16(1):121–31.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Newcomb ME, Mongrella MC, Weis B, McMillen SJ, Mustanski BS. Partner disclosure of PrEP use and undetectable viral load on geosocial networking apps: frequency of disclosure and decisions about condomless sex. JAIDS J Acquir Immune Defic Syndr (in press).Google Scholar
  22. 22.
    Hall HI, Holtgrave DR, Maulsby C. HIV transmission rates from persons living with HIV who are aware and unaware of their infection. AIDS. 2012;26(7):893–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Ekstrand ML, Stall RD, Paul JP, Osmond DH, Coates TJ. Gay men report high rates of unprotected anal sex with partners of unknown or discordant HIV status. AIDS. 1999;13(12):1525–33.CrossRefPubMedGoogle Scholar
  24. 24.
    Parsons JT, Severino J, Nanin J, et al. Positive, negative, unknown: assumption of HIV status among HIV-positive men who have sex with men. AIDS Educ Prev. 2006;18:139–49.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Grov C, Rendina HJ, Moody RL, Ventuneac A, Parsons JT. HIV serosorting, status disclosure, and strategic positioning among highly sexually active gay and bisexual men. AIDS Patient Care STDS (in press).Google Scholar
  26. 26.
    Pantalone DW, Tomassilli JC, Starks TJ, Golub SA, Parsons JT. Unprotected anal intercourse with casual male partners in urban gay, bisexual, and other men who have sex with men. Am J Pub Health. 2015;105(1):103–10.CrossRefGoogle Scholar
  27. 27.
    Bruce D, Kahana S, Harper GW, Fernández MI, the ATN. Alcohol use predicts sexual risk behavior with HIV-negative or partners of unknown status among young HIV-positive men who have sex with men. AIDS Care. 2013;25(5):559–65.CrossRefPubMedGoogle Scholar
  28. 28.
    Lovejoy TI, Heckman TG, Sikkema KJ, Hansen NB, Kochman A. Changes in sexual behavior of HIV-infected older adults enrolled in a clinical trial of standalone group psychotherapies targeting depression. AIDS Behav. 2014;19(1):1–8.CrossRefGoogle Scholar
  29. 29.
    Reilly KH, Neaigus A, Jenness SM, et al. Trends in HIV prevalence and risk behavior among men who have sex with men in New York City, 2004–2011. AIDS Educ Prev. 2014;26(2):134–43.CrossRefPubMedGoogle Scholar
  30. 30.
    Grov C, Golub SA, Parsons JT. HIV status differences in venues where highly-sexually active gay and bisexual men meet sex partners: results from a pilot study. AIDS Educ Prev. 2010;22:496–508.CrossRefPubMedGoogle Scholar
  31. 31.
    Liau A, Millett G, Marks G. Meta-analytic examination of online sex-seeking and sexual risk behavior among men who have sex with men. Sex Transm Dis. 2006;33(9):576–84.CrossRefPubMedGoogle Scholar
  32. 32.
    Kurka T, Soni S, Richardson D. MSM report high use of club drugs which is associated with high risk sexual behaviour. Sex Transm Infect. 2015;91(1):A4.CrossRefGoogle Scholar
  33. 33.
    Vial AC, Starks TJ, Parsons JT. Finding and recruiting the highest risk HIV-negative men who have sex with men. AIDS Educ and Prev. 2014;26(1):56–67.CrossRefGoogle Scholar
  34. 34.
    Golub SA, Kowalczyk W, Weinberger CL, Parsons JT. Preexposure prophylaxis and predicted condom use among high-risk men who have sex with men. J Acquir Immune Defic Syndr. 2010;54(5):548–55.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Grov C, Whitfield THF, Rendina HJ, Ventuneac A, Parsons JT. Willingness to take PrEP and potential for risk compensation among highly sexually active gay and bisexual men. AIDS Behav. 2015;19(12):2234–44.CrossRefPubMedGoogle Scholar
  36. 36.
    Parsons JT, Rendina HJ, Grov C, Ventuneac A, Mustanski B. Accuracy of highly sexually active gay and bisexual men’s predictions of their daily likelihood of anal sex and its relevance for intermittent event-driven HIV Pre-exposure prophylaxis. J Acquir Immune Defic Syndr. 2015;68:449–55.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Parsons JT, Rendina HJ, Ventuneac A, Moody RL, Grov C. Hypersexual, sexually compulsive, or just highly sexually active? Investigating three distinct groups of gay and bisexual men and their profiles of HIV-related sexual risk. AIDS Behav. 2015.Google Scholar
  38. 38.
    Stall R, Mills TC, Williamson J, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93:939–42.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Stall R, Paul JP, Greenwood G, et al. Alcohol use, drug use and alcohol-related problems among men who have sex with men: the Urban Men’s Health Study. Addiction. 2002;96(11):1589–601.CrossRefGoogle Scholar
  40. 40.
    Sharma AK, Sullivan PS, Khosropour CM. Willingness to take a free home HIV test and associated factors among internet-using men who have sex with men. J Int Assoc Phys AIDS Care (JIAPAC). 2011;10(6):357–64.CrossRefGoogle Scholar
  41. 41.
    New York State Department of Health and Mental Hygiene. Pre-exposure prophylaxis assistance program (PrEP-AP). 2014. Accessed 26 August 2015.
  42. 42.
    Huebner DM, Binson D, Pollack LM, Woods WJ. Implementing bathhouse-based voluntary counselling and testing has no adverse effect on bathhouse patronage among men who have sex with men. Int J STD AIDS. 2012;23(3):182–4.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Rosenberger JG, Reece M, Schick V, et al. Sexual behaviors and situational characteristics of most recent male-partnered sexual event among gay and bisexually identified men in the United States. J Sex Med. 2011;8:3040–50.CrossRefPubMedGoogle Scholar
  44. 44.
    Krakower DS, Mimiaga MJ, Rosenberger JG, et al. Limited awareness and low immediate uptake of pre-exposure prophylaxis among men who have sex with men using an Internet social networking site. PLoS One. 2012;7(3):e33119.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Hirshfield S, Chiasson MA, Wagmiller RL Jr, et al. Sexual dysfunction in a U.S. internet sample of men who have sex with men. J Sex Med. 2010;7:3104–14.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Hirshfield S, Schrimshaw EW, Stall RD, Margolis AD, Downing MJ, Chiasson MA. Drug use, sexual risk, and syndemic production among men who have sex with men who engage in group sexual encounters. Am J Public Health. 2015;105(9):1849–58.CrossRefPubMedGoogle Scholar
  47. 47.
    Taylor BS, Chiasson MA, Scheinmann R, et al. Results from two online surveys comparing sexual risk behaviors in Hispanic, Black, and White men who have sex with men. AIDS Behav. 2012;16(3):644–52.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Khosropour CM, Sullivan PS. Predictors of retention in an online follow-up study of men who have sex with men. J Med Int Res. 2011;13(3):e47.Google Scholar
  49. 49.
    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 Int Res. 2013;15(8):e194.Google Scholar
  50. 50.
    Grey JA, Konstan J, Iantaffi A, Wilkerson JM, Galos D, Rosser BRS. An updated protocol to detect invalid entries in an online survey of men who have sex with men (MSM): how do valid and invalid submissions compare? AIDS Behav. 2015;1–10.Google Scholar
  51. 51.
    Konstan JA, Simon BRS, Ross MW, Stanton J, Edwards WM. The story of subject naught: a cautionary but optimistic tale of Internet survey research. J Comput Mediat Commun. 2005;10(2).Google Scholar
  52. 52.
    Bauermeister JA, Pingel E, Zimmerman M, Couper M, Carballo-Dieguez A, Strecher VJ. Data quality in HIV/AIDS web-based surveys: handling invalid and suspicious data. Field Methods. 2012;24(3):272–91.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Teitcher JEF, Bockting WO, Bauermeister JA, Hoefer CJ, Miner MH, Klitzman RL. Detecting, preventing, and responding to “fraudsters” in Internet research: ethics and tradeoffs. J Law, Med Ethics. 2015;43(1):116–33.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Christian Grov
    • 1
    • 2
    • 3
  • H. Jonathon Rendina
    • 2
  • Jeffrey T. Parsons
    • 2
    • 3
    • 4
    • 5
    Email author
  1. 1.Department of Health and Nutrition Sciences, Brooklyn CollegeCity University of New YorkNew YorkUSA
  2. 2.Center for HIV/AIDS Educational Studies and Training (CHEST)New YorkUSA
  3. 3.Doctoral Program in Public HealthThe Graduate Center of CUNYNew YorkUSA
  4. 4.Doctoral Program in Health Psychology and Clinical ScienceThe Graduate Center of CUNYNew YorkUSA
  5. 5.Department of PsychologyHunter College of CUNYNew YorkUSA

Personalised recommendations