Findings by HIV testing decision
The findings presented below outline themes regarding ways in which stigma affects three HIV testing decisions: (a) whether to get tested, (b) where to get tested, and (c) how often to get tested.
Whether to get tested
“They had a slutty evening”: Perceived promiscuity, risk perceptions and HIV testing.
Some GBQMSM felt that testing, including repeatedly, would lead to stereotyping as sexually promiscuous—a stereotype applied to GBQMSM and judged as immoral. As this man said,
“If someone gets tested…frequently, then someone would assume that they are sexually promiscuous. The stigma is also there for that.” (FG8-1, White, Gay, 32, HIV-negative).
It was felt that this could make decisions to test less likely. Relatedly, GBQMSM expressed beliefs that testing was only necessary after “slutty” behavior. For example, a participant claimed that people get tested because “They had a slutty evening, truly.” (FG1-7, Black, Gay, 37, PLWH, 4.51-10.99 years since diagnosis) Similarly, identifying one’s behavior as promiscuous could prompt perceptions of being at risk and in need of HIV testing,
“I’m a ho. Card-carrying. And I’m a realist, okay? The last two guys I was with, I think they kinda cool but I have one… I think it’s questionable and I gotta get my ass up here and get tested. See what’s really goin’ on.” (FG3-12, Black, Gay, 64, HIV-negative).
However, concerns about promiscuity and HIV risk could also spawn fear and HIV test avoidance, as this participant explained,
“…this one period where I just refused to get tested…because I knew that I had been having way too much sex. It’s was like, ‘If I get a positive results back, I won’t know what’s gonna happen.’” (FG3-4, Black, Gay, 24, HIV-negative).
At the same time, not seeing oneself as promiscuous could facilitate inaccurate risk perceptions, and delayed HIV testing, as this participant who had tested only for an incentive explained,
“I thought I was doing everything right… I was like, I’m not a… I’m a wild girl, but [laughter]…I’ve been around but not around…” (FG2-7, Black, Gay, Age not given, PLWH, Years since diagnosis not given).
Multiple participants commented on moral judgement about perceived promiscuous behavior. Fear of such judgements from healthcare providers could further stand in the way of testing,
“It may be very hard to go in and get that test when you know you had sex with multiple people, unprotected, you know, ‘Here I go again.’” FG3-5 (Asian, Gay, 22, HIV-negative).
There was also acknowledgement that GBQMSM judged one another for perceived promiscuity, although opinions were mixed as to how pervasive or damaging this was. One joked that the GBQMSM community was divided into, “Those that admit to whoring around and those that don’t in particular.” (FG4-1, Latino, Bisexual, 45, HIV-negative) However, other men felt that stigma about “sluttiness” was a concern. A few men stated that this was a form of self-stigma. For example,
“…in my experience, gay men are…more judgmental about how many partners one has… it comes back to internalized homophobia… to deviation from the normal married with 2.2 kids standard, that you’re not following the rules of the society…” (FG8-3, White, Gay, 38, HIV-negative).
GBQMSM who were PLWH also mentioned the potentially damaging nature of the promiscuity and HIV stereotype to them personally, “I feel like I’m constantly being persecuted…People think it’s just, “Oh, you’re being loose.“ I was in a committed relationship.” (FG2-5, Black, Gay, 44, PLWH, Years since diagnosis not given) Such stigma, when expressed towards PLWH, may subsequently influence HIV-negative GBQMSM as well.
“When you’re online talking to someone, the first thing that comes up, ‘Are you clean?’”: Fearing sexual rejection.
Many participants, but particularly those under 30 years of age, highlighted fear of sexual rejection as a barrier to deciding to seek HIV testing. It was felt that having HIV made someone a “less desirable” sexual partner, which might undermine one’s ability to form relationships or result in being ignored or neglected. According to this man, this could be particularly difficult for GBQMSM who already had difficulty finding partners, “…If they’re someone who’s already low…‘Oh I have a hard enough time getting a guy, now I just gotta add HIV to it’ they’re not gonna [seek HIV testing].” (FG2-3, Black, Gay, 22, PLWH, 0-4.50 years since diagnosis).
Several participants stressed that the responsibility to disclose an HIV diagnosis would being emotionally challenging and undermine burgeoning sexual encounters,
“They’re afraid that if they find out that they’ll be stigmatized and then they have a duty at that point to tell people…and then if you do wanna go out and have hook-ups, it’s kind of a deflating statement if you went and said to somebody right before sex that ‘Oh, I’m HIV positive.’” (FG4-3, White, Gay, 29, HIV-negative).
Participants’ sensitivities to the possibilities of sexual rejection were acute after having witnessed stigmatizing online interactions concerning HIV—especially on hookup apps such as Grindr and Scruff. Although most rejected the practice themselves, many participants highlighted the prevalence of online profiles that stated an interest only in HIV-negative men on such sites. As this man said,
“…I’ve also seen the kind of social stigma around [HIV] impact people to be fearful of even being tested, but the fear of knowing… I’ve seen people be shunned [on hookup apps] because of it…” (FG9-8, White, Gay, 27, PLWH, 0-4.50 years since diagnosis).
A participant, however, admitted to personally rejecting potential partners on the basis of HIV status,
“…on…dating apps…“…if you see an HIV positive tag on someone’s profile, I know a lot of people myself included, just ignore that person. I think a lot of people are just afraid of getting HIV and don’t want to take any sort of risk, and find it easier to just kind of ignore that person than to take other types of precautions and still give the person a chance.” (FG7-7, White, Gay, 25, HIV-negative).
However, participants noted a counter-trend towards resisting stigma on the same sites,
“I think you see that a lot on Grindr profiles and Scruff profiles, where it’s some people are very affirming. They’ll put the equal sign within their name. They don’t sort by their status but other times you see people say ‘clean only.’” (FG8-4, White, Gay, 23, HIV-negative).
Participants also complained about the ubiquitous use of the term “clean” to designate “HIV-positive status” when negotiating sexual encounters. Typically, participants perceived this question as an effort to quickly sort “HIV-positive” from “HIV-negative.” One said,“It’s jarring when you’re online talking to someone, and the first thing that comes up, ‘Are you clean?’” (FG6-2, Black, Gay, 56, HIV-negative). GBQMSM who were living with HIV found cleanliness metaphors common, painful, and demeaning. A few men also expressed disappointment that they were not privy to more substantive HIV-related discussions than “are you clean?” in the community.
Additionally, a few participants experienced social judgement due to relationships or sexual encounters with PLWH, which further shaped their perceptions of the potential for sexual rejection. For example, a participant was surprised when a friend dated a positive man, and another said,
“I’ve had people after finding out that I have slept with people that I knew were positive, like, ‘Why would you do that?’… I perceive the stigma…as [a] higher barrier than the fear of being positive…having to say that when negotiating sex or… put that on your profile.’” (FG7-8, White, 26, Queer, HIV-negative). However, a few expressed the belief that PrEP and TasP had begun to soften some of the HIV-related divisions between GBQMSM. Yet several cited mandatory disclosure laws, which were in place in Michigan at the time of the study, as disincentivizing testing,
“I think our current legal system with the mandatory disclosure laws and everything, it does not encourage testing because it basically is like, ‘If you don’t know, you’re fine.’” (FG3-6, Asian, Gay, 21, HIV-negative).
“I’m not gonna have that happen to me and my family”: Fearing friend and family member distancing and rejection.
According to participants, the possibility of rejection from friends or family members could provide a barrier to the decision to seek HIV testing. Particularly a concern among Black and older White participants, there was a feeling that people could lose valued social relationships as a result of an HIV diagnosis. A man said,
“I probably would have never [gotten tested] until my guy I was talking to told me to do it, and we went together. Because I would’ve thought that if I was positive I was gonna lose my family…” (FG1-8, Black, Gay, 45, PLWH, 4.51-10.99 years since diagnosis).
In addition to fears grounded in one’s personal family relationships, participants who were PLWH felt that others hearing “horror stories” about their experiences could deter them from testing,
“S: Falling out with my family, right? Right, so if I’m with somebody and they haven’t had that experience, and they hear me talking, they’re like, ‘Oh no, fuck that. I’m not gonna have that happen to me and my family, because I wanna be close to them.’” (FG1-7, Black, Gay, 37, PLWH, 4.51-10.99 years since diagnosis).
Another participant was deeply affected by the stigma that he had witnessed early in the epidemic, and he had avoided testing out of fear for many years,
“[I] remember the bad old days…That was really when people were sick and shunned…People are afraid to know their status…They’re afraid to be stigmatized by people finding out that they’re HIV positive…myself, when I was younger, [fear of stigma] did [affect my HIV testing decisions].” (FG8-3, White, Gay, 38, HIV-negative).
Relatedly, participants spoke of negative experiences in which family members or friends attempted to distance themselves due to perceived contagion after they received a positive HIV test. Events included wearing gloves at a participant’s house, wanting separate toothpaste, a request to not bring food to a family cookout, anxiety about accidentally sharing water, and anger at someone holding a child. While most of these events had taken place in the past, some were recent. Regardless of timing, these forms of enacted stigma remained distressing for PLWH participants, and for them, remained a factor making testing more difficult for others,
“…[friends] don’t wanna talk to you anymore, they don’t want you to be around their kids. They’re just not sure what to do…so you lose people…You have to start all over again almost, especially if you don’t have a supportive family.” (FG3-1, Black/Latino, Gay, 53, PLWH, 22-31 years since diagnosis).
Where to get tested
“Guilty until proven innocent”: Conflating HIV testing and diagnosis.
Many Black participants expressed concerns about being labeled “HIV-positive” by others if others learned of their HIV testing behavior. Here, the mere association of one’s name or identity with testing was enough for others to assume they were living with HIV,
“All you have to do is say, “I’m going to go get a HIV test.“ Right? Whether it’s positive or negative, you’ve already identified yourself with HIV. So, it’s an assumption that that is your diagnosis, whether it is or not.” (FG1-1, Black, Gay, Age not given, PLWH, Years since diagnosis not given).
Furthermore, this labeling of testers as positive could be long lasting, “…if you say something, it just sticks… they don’t hear, ‘I’m gonna get tested for HIV…’ They hear, ‘HIV’… (FG3-1, Black/Latino, Gay, 53, PLWH, 22-31 years since diagnosis) Participants felt that others might assume they were living with HIV, either if they disclosed testing behavior, or if they were seen at an HIV testing location, especially within smaller communities “I’m constantly running to people I know. So in this area, who wants to be seen getting a test or be associated…?” (FG1-3, Black, Gay, 25, PLWH, 4.51-10.99 years since diagnosis).
Several participants felt that although a man’s HIV test might be negative, he might still face social consequences due to testing, such as rejection or being the subject of gossip, especially, “when everybody basically knows everyone.” (FG6-5, Black, Gay, 33, PLWH, 11-21.99 years since diagnosis). A few participants further expressed concern about the potential for gossip about their HIV status. As one said,
“…the main issues was in the black community, the ballroom scene,…you’re guilty until proven innocent. If I walk into an STD clinic and I know that they test for HIV here, I see you here, I’m already gonna think, “Oh, you’re positive. Let me go tell everybody.” (FG6-5, Black, Gay, 33, PLWH, 11-21.99 years since diagnosis).
This primarily led to concerns about privacy during testing, particularly when in clinic waiting rooms or seeking services within one’s community. A participant explained,
“I’m in Detroit, I’m a black male, right? They have these black organizations all over Detroit. Oh, hell no. I went to the Hispanic organization down in Southwest Detroit, and if there was a blizzard or a thunderstorm, they could expect me as a walk in, okay? I will be there… I wanted to be in there with nobody else.” (FG3-12, Black, Gay, 65, HIV-negative).
“I refuse to get tested anywhere else”: Seeking privacy and safety at specialized services.
Many participants sought HIV testing from services that they believed would spare them negative experiences of stigma about their sexual behavior—including AIDS Service Organizations (ASOs), community health centers or GBQMSM-competent physicians. Some of these participants described experiencing stigma from healthcare providers, whether in relation to testing, PrEP or PEP care that resulted in decisions to seek testing in different locations in the future. For example, one said,
“I went to go get a PEP [Post-Exposure Prophylaxis] after a really bad experience…Was turned away from two ERs [Emergency Rooms]. One doctor was incredibly homophobic. I was bawling…[now] I refuse to get tested anywhere else besides [LGBT nonprofit that partners with county public health] or [ASO]” (FG5-4, White, Queer, 26, HIV-negative).
Another participant reported denial of care from a clinician after he asked him numerous invasive questions,
“I had a family practice nurse practitioner, unfortunately, deny me STI testing and prescribing PrEP and actually told me to go to Planned Parenthood… There still is a lot of stigma and that was probably the most slap in the face I had ever had…” (FG8-1, Gay, White, 32, HIV-negative).
In addition to care denial, some participants reported unpleasant reactions from clinicians when they discussed their HIV prevention needs. One man explained,
“I had a doctor who I said I want to have HIV testing and he looked at me like, ‘You’re gay?’ It was like… So that would be a hindrance. Of course, I also switched doctors… I went to a gay doctor.” (FG4-2, Gay, White, 49, HIV-negative).
As suggested above, such experiences led to decisions to change providers to those thought to be more competent in GBQMSM care. However, concerns about the competence of physicians also intersected with issues related to insurance access; participants felt that having good health insurance increased the odds of having good experiences. As this participant said,
“I got really good healthcare. So I got tested in January from my doctor…I have access to get my blood taken from the lab at my doctors so I think it’s all about access.” (FG9-6, White, Gay, 45, HIV-negative).
However, younger men insured under their parents’ plans feared their parents learning about their HIV testing behavior. This man whose last test was through an LGBTQ community center said,
“As a dependent of parents who don’t know that I’m gay, I think having a HIV test on your insurance statement can really cause some problems. And…I’ve had some really bad experiences with doctors that are not very LGBTQ friendly….” (FG3-6, Asian, Gay, 21, HIV-negative).
In fact, some study participants said that they had experienced unwanted parental disclosures of their sexual health service use due to relying on parents’ insurance and payment for care. Other insurance concerns related to employment and possible insurance discrimination, which resulted in seeking anonymous testing,
“I would always…get tested anonymously because I didn’t want my insurance company to know…If I had seroconverted, hi, preexisting condition. ACA doesn’t exist yet. I am screwed.” (FG7-4, White, Gay, 48, HIV-negative).
How often to get tested
Among participants, there was general acknowledgement that GBQMSM who were not in monogamous relationships should be tested more than once, or “regularly.” As this man said, “If you’re not monogamous, sexually active gay man, it’s just responsible to get tested
regularly.” (FG3-9, White, Gay, 33, HIV-negative) However, participants believed that stigma stimulated deviation from this ideal; at the same time, stigma about non-testing supported frequent testing in some GBQMSM subgroups.
“People have a fear of health systems and doctors”: Reducing contact with healthcare providers due to intersectional stigma.
Black GBQMSM expressed opinions that HIV testing might occur less frequently than recommended due to histories of, and direct experiences of, racism as a form of intersectional stigma. As one said, “…there are a lot of culture and historical implications to just the African-American culture as a whole, why people have a fear of health systems and doctors…” (FG5-1, Black, Bisexual, 45, PLWH, Years since diagnosis not given). Similarly, a participant noted a tendency to be discounted by physicians, which could result in disengagement, “…when you have doctors that don’t really listen to you, it’s hard to wanna go back and be seen or whatever. Some people just give up.” (FG6-5, Black, Gay, 33. PLWH, 0-4.50 years since diagnosis). Such experiences could reduce opportunities for HIV testing, as this man explained,
“Black men don’t go to doctors very regularly…We’re supposed to have an annual checkup every year…but before [I was diagnosed], I wouldn’t go see a doctor unless I was really, really sick…So a lot of people are not doing [HIV testing] because of what they’re afraid they’re gonna hear. They’re not doing it because we just don’t go to doctors.” (FG5-13, Black, Gay, 56, PLWH, 0-4.50 years since diagnosis).
Similarly, a transgender participant noted that concerns about transphobia as a form of intersectional stigma in healthcare made testing more difficult for him as a GBQMSM,
“…for trans people, even the idea of going to the doctor is really anxiety-provoking…knowing that you’re likely not going to be treated well and might have to extend a lot of the emotional health as well in order to get [HIV testing].” (FG7-8, White, Queer, 26, HIV-negative).
By contrast, men noted that access to resources could moderate the frequency of negative experiences, and make it easier to have regular provider contact that facilitated HIV testing.
“…socioeconomic status and privilege…I always benefited from extremely good health insurance with all the bells and whistles, and that hasn’t changed. And so even when I came out and started sleeping with guys, I knew that I would have exceedingly good health care. I knew that I could go to my doctor, and I wouldn’t be judged or mistreated…[that] has a tremendous impact in terms of whether or not you decide to get tested and make that a regular part of your lifestyle.”(FG3-5, Asian, Gay, 22, HIV-negative).
“I think the bigger stigma is not getting tested nowadays”: Responsibility and regular testing.
Some participants acknowledged significant pro-testing norms among their associates—although they felt this might be limited to certain subgroups of GBMSM, such as those affiliated with the university or in a polyamorous community. Such participants described a pressure to test, with non-testing and irregular testing emerging as shameful, newly stigmatized behaviors. As these men said,
“FG3-6: I think the bigger stigma is not getting tested nowadays…‘When was the last time you got tested?’ But we also live in a university town and things are different here… (Asian, Gay, 21, HIV-negative).
FG3-9: I see the same thing, but not just locally. I think on Reddit or other discussion boards, there’s definitely a norm that now people expect you will be getting tested regularly unless you’re in a monogamous relationship… (White, Gay, 33, HIV-negative).
FG3-8:…I think definitely there is that peer pressure to get tested in my circles, like, ‘Really? You haven’t yet? With the type of stuff you’re doing, you need to be going more than once a year, twice a year’…” (White, Queer, 26, HIV-negative).
Participants noted the influence of HIV/AIDS-related public health and ASO outreach in developing these pro-testing norms. Specifically, they promulgated positive messages that could make GBQMSM feel good about testing, as one participant-test counselor stated. Noting the influence of such messages, a participant said,“‘you get tested every six months.’ That was drilled in my head, whether you’re straight or gay, bi.’” (FG1-8, Black, Gay, 45, PLWH, 4.51-10.99 years since diagnosis).
Building on these messages, participants associated HIV testing—especially regular testing—with personal responsibility, praising testing as an expression of caring about one’s own health and that of others. Participants saw an emphasis on responsibility as an alternative to sexually stigmatizing messaging, “I think the most important thing is, just frame [testing] in terms of being responsible and taking ownership of your health. So the whole idea of slut shaming doesn’t have to even come up.” (FG7-7, White, Gay, 25, HIV-negative).
When discussing testing as a personal responsibility, GBQMSM participants characterized responsibility to test as having two dimensions: to one’s own health, and that of others. As this man said,
“If you don’t get tested, I feel that’s just very shameful, in my eyes…That you don’t…care about your health or the health of others.” (FG3-7, White, Bisexual, 31, PLWH, 0-4.50 years since diagnosis).
To participants, regular testing was clearly an issue of morality, “The people that are getting tested, it’s like they genuinely care about others. And they care about themselves as well. Their morals are really up here.” (FG4-4, Black, Gay, 31, PLWH, 22-31 years since diagnosis) Relatedly, GBQMSM characterized non-testing as willful ignorance maintained in order to avoid taking responsibility for stopping the spread of HIV. As these participants said,
FG4-2: And it’s better, in their mind, it’s better to not know and then that way you don’t feel guilty if you go out and have unprotected sex…(White, Gay, 49, HIV-negative).
FG4-4: Yes. Oh my God. (Black, Gay, 31, PLWH, 22-31 Years since diagnosis)
FG4-1: Because then you don’t know if you’re passing it on or not. (Latino, Bisexual, 45, HIV-negative)
This specifically became a flight from the responsibility to practice safer sex, according to another man, “‘Out of sight, out of mind.’ Where if they don’t know, they can’t be responsible, ‘Well, I didn’t know I had it.’ But if you know that you had it and you gave it to somebody, that’s being irresponsible.” (FG5-9, Black, Gay, 62, PLWH, 11-21.99 years since diagnosis) PLWH particularly chastised this behavior, as well as non-disclosure of HIV status to potential partners or those who did not take the possibility of spreading HIV seriously, contrasting their own behavioral commitments to such conduct, as this man stated,
“…you have those out there that…pass it around…those are the people that I have an issue with because they make the rest of us look bad. And I’m not like that, me personally. That’s how I’ve always been. I care about everybody because I care about myself too much and I care about everyone else. So that just pisses me off.” (FG4-4, Black, Gay, 31, PLWH, 22-31 years since diagnosis).
In terms of one’s own health, participants attributed a number of virtues to regular testers in addition to responsibility: maturity, realism, and positive self-esteem. As this man said,
“The people that’s not getting tested, you can look at other aspects of their life and they seem real childish, they make stupid decisions and they don’t really take care of themselves…And they’re probably more self-aware, too.” (FG5-6, Black, Gay, 31, PLWH, 11-21.99 years since diagnosis).
Additionally, positive self-esteem was linked to lack of internalized homophobia, with one man claiming that people who do not test regularly and proactively are those who, “…won’t readily accept that they’re gay that have some self-loathing” (FG9-5, White, Gay, 53, HIV-negative).
For some men, this moral pressure was linked to sharing testing behavior as a form of self-presentation as a “responsible person,” either in dialogue with other GBQMSM or online, “I think some people will put on their profile, negative as of this recent data, look at me being so responsible. I think some people are driven by that.” (FG7-7, White, Gay, 25, HIV-negative) Because of the moral value attached, regular testing could be a way to resist stigma associated with presumed sexual immorality,
“I got a lot of…stigma from family and for me, getting regularly tested, and showing that it’s possible to be sexually active and still be responsible and take care of my health was a way of proving to my family that, no, you’re wrong.” (FG3-5, Asian, Gay, 22, HIV-negative).
Notably, some HIV-positive participants criticized this moral pressure to test regularly for HIV, highlighting the importance of being “ready” for the personal impact of an HIV test—both mentally and socially. Without appropriate supports, they felt, delaying or avoiding testing was an important alternative. These men resisted what they perceived to be moral pressures around HIV testing, arguing that messages could be simplistic and fail to take the difficult realities of testing positive into account. As this man said,
“People automatically assume, especially people in the healthcare field, especially people at the university… ‘Get tested! Get tested! It’s the right thing to do. It’s a no-brainer. Just get tested. It’s responsible and you should feel like crap if you don’t…However, there is a whole mess of baggage that comes with that, that you actually need to weigh the pros and cons of that very carefully…” (FG2-4, Black, Gay, 37, PLWH, 11-21.99 years since diagnosis).
Participants highlighted the immense consequences of a positive diagnosis for their mental health, for example, “…if it puts you in a state of being suicidal, it doesn’t solve anything. If a week difference or a year difference would circumvent you wanting to be suicidal…. just earlier the better? I don’t believe that, especially if you’re alone, you have no parents…” (FG2-2, Black, Bisexual, 41, PLWH, 4.51-10.99 years since diagnosis). Similarly, another man described his experience of testing positive as deeply traumatic, arguing for the right to delay testing of one was not ready. He said,
“I really wasn’t prepared for all that was about to happen to me…even being positive or not, if I just waited three years…I would have had three more years of freedom, three less years of stigma…and then I’ll deal with that when I’m on my deathbed.” (FG2-3, Black, Gay, 22, PLWH, 0-4.50 years since diagnosis).
Without appropriate supports, these participants felt that delaying or avoiding testing was an important alternative to early testing. Thus, a downside of moral pressure to get an HIV test could be people learning of their HIV positive status when ill-equipped to deal with this new reality.
“It just came along with the check-up”: HIV stigma and testing as routine care.
In terms of linking HIV testing to personal health care, several participants discussed regular HIV testing as a form of routine care—not something shameful or a response to “bad” behavior. These statements typically compared HIV testing to healthcare for other, non-stigmatized conditions, as these men said,
“You’re supposed to get a check up every six months to a year…if you get a check up, that should be something on the list. Cholesterol, blood pressure, HIV.” (FG4-2, White, Gay, 49, HIV-negative).
“Some of us…we’re raised with this as something that they were very conscious of, started getting tested before we started having sex, and it’s just part of life, and we’re used to it. Every six months, the same way that I get my dentist appointment, I get my test.” (FG7-8, White, Queer, 26, HIV-negative).
For participants, framing HIV testing as routine care challenged the differential treatment inherent in stigma. More broadly, GBQMSM identified integration of HIV testing into other healthcare as a valuable stigma reduction strategy that might increase comfort with seeking testing. This approach was supported by healthcare providers—whom participants viewed as GBQMSM-competent—offered HIV testing as part of routine care,
“When I looked at another city, I went to a specifically gay doctor practice [chuckle] and it didn’t matter if I wanted it or not, he was like, “You’re gonna get tested,“ it just came along with the check-up.” (FG3-10, White, Gay, 33, HIV-negative).
More broadly, participants identified integration of HIV testing into other forms of healthcare as a stigma reduction strategy,
“…they should try to avoid an organization meant for just …coming for [HIV] testing. It should be like, for example, in a hospital where people come for diabetes, people come for heart problems, they just do testing. So you can’t tell, because usually people are free to come in to a building like this…” (FG1-6, White, Gay, 50, PLWH, Years since diagnosis not given).