Results suggest that within a racially and ethnically diverse sample of MSM and MSM/W in Los Angeles, unrecognized HIV infection is associated with race/ethnicity, gender of sexual partner, and homonegativity scores. Race/ethnicity, gender of sexual partner, homonegativity, education, and cocaine use (urine screen) were entered as potential predictors into a multivariate analysis. Race/ethnicity, gender of sexual partner and homonegativity score were significant predictors of correct knowledge of actual HIV status, controlling for age, and homelessness.
Consistent with findings from this large sample, the CDC reported unrecognized infection rates of 48% in a sample of HIV positive MSM. They found that HIV positive MSM who were Non-White (rather than White), less than 30 (compared to over 30), and surveyed in Los Angeles, New York, Baltimore, or Miami (rather than San Francisco) were less likely to be aware of their HIV positive status [5
]. Though parallel, our findings are based on a sample of MSM and MSM/W who averaged over 40 years of age, reported high homonegativity scores and were very poor. This suggests that poor MSM and MSM/W from communities of color from across the age spectrum are significantly less likely to have accurate knowledge of their current HIV status. Building on past studies of predictors of unrecognized infection, results of this analysis suggest that high homonegativity is a strong predictor of lack of knowledge of HIV status. Future analysis in this area might be used to build on theories of HIV syndemics [21
] to determine whether the interaction of psychological and behavioral variables might further reduce recognition of HIV status.
Consistent with prior work suggesting that stigma may reduce perceived risk and willingness to test for stigmatized diseases [6
], we found higher homonegativity scores associated with unrecognized HIV positive status. Understanding and addressing associations between homonegativity scores and stigma [23
] may improve the design of interventions to facilitate regular HIV testing for MSM communities of color in urban areas. Targeting interventions toward MSM/W, populations of color, and populations with high levels of HIV-related stigma may help to increase testing and treatment and reduce rates of unrecognized HIV.
Study limitations are based on the self-reported nature of findings in a localized population. The convenience sample of poor, ethnic MSM and MSM/W in Los Angeles makes it difficult to generalize findings outside of this community. However, the unique composition of this sample makes it ideal to study to better target prevention and treatment strategies at populations that face disproportionate rates of HIV infections. Second, the stigmatization associated with HIV may have led some participants to underreport being HIV positive, inflating the number of unrecognized infections. Internalized homonegativity scores likely measure only one aspect of stigmatization associated with HIV. Although we included race and education as controls, we were unable to control for other possible variables such as symptoms (people aware of their HIV positive status might have presented with symptoms while unaware participants might not have had symptoms), risk perception (aware participants might have perceived themselves at greater risk and felt a greater need to find their HIV status), and contact with other people with HIV/AIDs (aware participants may have known other people with HIV/AIDS increasing their knowledge about HIV). Finally, the results from the present analysis are based, in part, on a relatively small sample of unrecognized positives. However, because of the scarcity of research on people with unrecognized HIV, we think this is an important contribution to the literature. Additionally, these results are both internally consistent both with the models presented in this study, as well as consistent with past studies on populations of people with unrecognized HIV [5