Assessing Reactions to Testing HIV Negative in a Linguistically Diverse Sample of Latinx Sexual Minority Men: Opportunities for Social Work Counseling and Risk Reduction

Background: Latinxs in the U.S. comprise an increasing proportion of new HIV diagnoses among gay, bisexual, and other sexual minority men (SMM). Among the many effective HIV prevention strategies available, frequent HIV testing has been promoted among SMM to reduce the risk of HIV transmission. While the benefits of HIV testing are well established, there has been little attention to the potential ramifications of testing HIV-negative for engagement in preventive practices, particularly in Latinx SMM.

Testing negative for HIV can result in varied reactions, which may influence subsequent HIV transmission risk behaviors such as condomless anal sex (CAS). The Inventory of Reactions to Testing HIV Negatives (IRTHN)developed by Mustanski and colleagues (2014) identified three different types of reactions to testing HIV-negative: 1) luck, 2) reinforced safety, and 3) invulnerability. The goal of the present study was to psychometrically validate the IRTHN for use among Latinx SMM in the U.S. in English and Spanish. Additionally, we examined whether the IRTHN was associated with subsequent CAS in this population.

Methods: Data for the current study were drawn from a national study that longitudinally followed a large cohort of diverse SMM in the U.S. We used data from the baseline and 12-month follow-up assessments and focused analyses on HIV-negative Latinx SMM (n=3049). Surveys were completed online via Qualtrics in either English or Spanish.

Participants completed the IRTHN, a 16-item scale assessing reactions to testing HIV negative, which included subscales of luck, reinforced safety, and invulnerability. We also assessed instances of CAS at baseline and at 12-month follow-up.

We conducted a multigroup confirmatory factor analysis in Mplus by comparing the latent constructs between respondents who completed surveys in English and Spanish. We then used the IRTHN measure in a regression model to examine the impact of IRTHN at baseline on CAS at 12-month follow-up. We also tested the interaction effects of IRTHN and CAS at baseline on CAS at 12-month follow-up. Models were adjusted for demographic characteristics and were conducted using SPSS v 25.

Results: Partial invariance was observed using the IRTHN in English and Spanish respondents. The interaction between the luck subscale and baseline CAS was significant (RR = 1.01; 95% CI 1.01, 1.02; p = 0.027. The interaction between the invulnerability subscale and baseline CAS was also significant (RR = 0.99; 95% CI 0.99-0.99; p = 0.004).

Implications: Our results demonstrate that the IRTHN may be appropriate for identifying Latinx SMM who may require additional HIV counseling to reduce HIV risk behaviors after testing HIV-negative. Specifically, Latinx SMM who score high on luck and high on invulnerability may be more likely to engage in CAS. Findings have practice implications for informing strategies that may mitigate HIV risk in Latinx SMM. Attention to the diverse cultural and social contexts in which behaviors take place remain critical for determining how social work counseling efforts can leverage understanding of reactions to HIV testing to facilitate risk reduction among Latinx SMM.