Background
Significant gaps remain in ending the HIV epidemic in the US, calling for the need for community tailored evidence-based HIV testing strategies.
Methods
To understand perceptions and underlying beliefs around HIV testing, particularly among Black, queer, and young people, we conducted a Best-Worst Scaling (BWS) survey among adults (16+) in the St. Louis, Missouri region. We recruited at community events, collected data electronically, and provided $25 incentives for survey completion. BWS was used to quantify the relative importance of 13 potential barriers (attributes) to HIV testing (e.g., stigma, structural barriers, perceived HIV risk) selected from the literature and reviewed by community members. BWS scores, calculated from participants’ most and least selected relevant barriers among 4 options across 13 choice sets, were rescaled using Hierarchical-Bayes estimation (out of 100). To explore preference heterogeneity among participants, we fit latent class conditional logit models.
Results
Among 152 participants surveyed, 52.7% identified as women, 38.8% as men, and 6.6% as non-binary. 49.3% identified as Black with a median age of 29 years (IQR 23-37). 49.4% identified as gay or lesbian, bisexual, and other non-heterosexual sexual orientations. Across the BWS, the most relevant barrier to HIV testing was that participants did not think they were at risk for HIV (BWS Score: 13.86, 95% CI 12.54-15.19). Black participants selected lacking trust in testing organization and peers not suggesting testing as more relevant barriers compared to White participants (p=0.03, 0.003, respectively). Queer respondents selected stigma associated with HIV positivity, access to testing, and fear of a positive result as more relevant barriers compared to heterosexual participants (p<0.001, 0.023, 0.004). Using latent class models, two underlying groups emerged including 1) “Low-risk perceivers” (67%) for whom the most salient attributes were low perceived risk for HIV (16.74, 15.41-18.07) and that testing had not been recommended by a health care worker (11.94, 10.68-13.21), and 2) “Fearful avoiders” (33%) who were worried they would be stigmatized if HIV positive (17.14, 16.03-18.26) and were afraid of being HIV positive (16.14, 14.46-17.82).
Conclusions
This best–worst scaling study informs our understanding of barriers to HIV testing around St. Louis, identifying that most believe they were not at risk for HIV nor need an HIV test. We should tailor testing strategies to all community members.
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