Detailed Knowledge About HIV Epidemiology and Transmission Dynamics and Their Associations With Preventive and Risk Behaviors Among Gay, Bisexual, and Other Men Who Have Sex With Men in the United States

BACKGROUND: Gay, bisexual, and other men who have sex with men (GBMSM) in the United States remain disproportionately affected by human immunodeficiency virus (HIV). Yet their testing frequency is suboptimal and condomless anal sex (CAS) is increasing. Behavioral theories posit that information about HIV is a pivotal construct in individual risk reduction. However, measurements of knowledge have traditionally focused on ever hearing about HIV and being aware of the most common routes of spread. OBJECTIVE: Using a national Web-based sample of sexually active GBMSM, we sought to (1) quantify levels of detailed knowledge about HIV epidemiology and transmission dynamics, (2) describe variations in detailed knowledge levels across demographic strata, and (3) evaluate potential associations of increasing levels of detailed knowledge with HIV testing in the past year and engaging in CAS with a male partner in the past 3 months. METHODS: GBMSM were recruited through a social networking website (Facebook) from August to September 2015 and asked 17 knowledge-based questions pertaining to the following 2 domains using a Web-based survey: HIV epidemiology (9 questions including statistics on incidence, prevalence, and distribution) and HIV transmission dynamics (8 questions including modes of spread and per-act transmission probabilities). Ordinal domain-specific indices of detailed knowledge were created for each respondent by summing their number of correct responses. Separate cumulative logit models were used to identify factors independently associated with each index, and multivariable logistic regression models were used to characterize associations with HIV testing history and recently engaging in CAS. RESULTS: Of the 1064 participants in our study, only half (49.62%, 528/1064) had been tested for HIV in the past year, and almost half (47.84%, 509/1064) had engaged in CAS with a male partner in the past 3 months. Majority scored 3 of 9 epidemiology questions correct (26.88%, 286/1064) and 5 of 8 transmission dynamics questions correct (25.00%, 266/1064). Participants younger than 35 years, of non-Hispanic non-white or Hispanic race and ethnicity, with lower educational levels, and who reported a sexual orientation other than homosexual or gay were significantly less knowledgeable about HIV transmission dynamics. Increasing levels of knowledge about this domain were independently associated with testing in the past year (adjusted odds ratio for each additional correct response: 1.10, 95% CI 1.01-1.20) but not with recent CAS. Increasing knowledge about HIV epidemiology was not associated with either outcome. CONCLUSIONS: Increasing detailed knowledge about HIV epidemiology might not be as important as educating sexually active GBMSM regarding transmission dynamics. Researchers and practitioners designing prevention messages targeting GBMSM should bear in mind that not all knowledge is equal and that some aspects might have a greater positive impact than others. Future research to identify influential content and contemporary modes of delivery is needed.