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Predictors of HIV testing among men who have sex with men: a focus on men living outside major urban centres in Canada


Men who have sex with men (MSM) represent almost half of new HIV infections in Canada each year. However, the vast majority of research on HIV testing among MSM has been conducted in major urban centres.

The main objectives of this study were to examine HIV testing rates and factors associated with HIV testing among MSM living outside major urban centres.[1]


MSM living in the Interior Health Region of British Columbia were recruited from online dating sites, events targeted at the gay community, and posters in the community. 

A total of 153 MSM completed an anonymous online survey that assessed HIV testing behaviour and psychosocial factors that may impact HIV testing.

Key findings

Almost one-quarter (24%) of participants had never been tested for HIV and over one-third (35%) had not disclosed same-sex attraction to their health care providers. Informal involvement in the gay community was low, with 43% of participants spending little to no social/leisure time with gay/bisexual men during the previous three months.

Internalized homophobia (i.e., the internalization of society’s negative attitudes towards lesbian, gay, bisexual, and transgendered individuals) was associated with a lower likelihood of HIV testing. This was, in part, because men with higher internalized homophobia were less likely to disclose same-sex attraction to their health care providers.

Implications for practice

The proportion of MSM in our study that had never been tested for HIV was higher than non-testing rates found in major Canadian cities (14-17%) [2,3], suggesting the need for public health initiatives to increase testing rates in these areas.

Our findings suggest that more open communication between MSM and their health care providers about same-sex sexual behaviour might increase HIV testing rates. However, routine HIV testing practices, such as those outlined in the provincial recommendations, are also expected to have a positive impact on HIV testing rates. 

Low rates of disclosure to health care providers may reflect MSM’s concerns that their health care providers have negative attitudes towards sexual minorities and/or a fear that they may be uncomfortable treating LGBT patients. These concerns may not be unfounded, as previous research has revealed that some providers feel uncomfortable discussing sexual health with MSM and in treating MSM more generally. Our findings suggest the need for more comprehensive education for medical professionals regarding sexual minority health during medical school and continuing medical education credits.

Lastly, the presence of internalized homophobia in our sample, and the negative health implications of internalized homophobia, indicate an urgent need for multi-level interventions that address individual and society factors that contribute to these negative and harmful views.

For more information

For further information, please contact Dr. Susan Holtzman.


  1. Holtzman S, Landis L, Walsh Z, Puterman E, Roberts D, and K Saya-Moore. (2016).  Predictors of HIV testing among have sex with men living outside of major urban centres in British Columbia. AIDS Care, 28(6), 1-7.
  2. Ha S, Paquette D, Tarasuk J, Dodds J, Gale-Rowe M, Brooks JI, Kim J, and T Wong, (2014). A systematic review of HIV testing among Canadian populations. Canadian Journal of Public Health, 105(1), e53–e62.
  3. Public Health Agency of Canada [PHAC], Center for Communicable Diseases and Infection Control. (2013). Population specific HIV/AIDS status report: gay, bisexual, two-spirit and other men who have sex with men. Retrieved from http://www.phac-aspc.gc.ca/aids-sida/publication/ps-pd/men-hommes/index-eng.php


This research was supported by a grant from UBC Okanagan’s Institute for Healthy Living and Chronic Disease Prevention and was conducted in close collaboration with the Living Positive Resource Centre, Okanagan. Co-authors on this work were: Daryle Roberts, Kevin Saya-Moore, Lisa Landis, Dr. Zach Walsh, and Dr. Eli Puterman.