Young men who have sex with men have the highest risk for HIV infection, but only one in five has ever been tested for HIV, a much lower rate than testing for non-adolescents, reports a new national Northwestern Medicine study conducted in partnership with the Center for Innovative Public Health Research.

The greatest barriers to these teenage males getting tested are not knowing where to go to get an HIV test, worries about being recognized at a testing site and — to a lesser degree — thinking they are invincible and won’t get infected.

“Understanding the barriers to testing provides critical information for intervening, so we can help young men get tested,” said study first author Gregory Phillips II, a research assistant professor of medical social sciences at Northwestern University Feinberg School of Medicine and an investigator for the IMPACT LGBT Health and Development Program at Feinberg.

“Rates of new HIV infections continue to increase among young gay and bisexual men,” said Brian Mustanski, principal investigator of the study, an associate professor of medical social sciences at Feinberg and director of IMPACT. “Testing is critical because it can help those who are positive receive lifesaving medical care. Effective treatment can also help prevent them from transmitting the virus to others.”

The study on low HIV testing rates for gay young men was published Aug. 26 in the Journal of Adolescent Health.

The findings suggest testing can be increased by providing young men with an easy way to find nearby testing sites via text messaging or online programs and by opening testing sites in high schools.

“Providing in-school testing would normalize the process,” Phillips said. “If there is a constant presence of on-site testing at schools, testing would seem less stigmatized. It would also increase knowledge about the testing process and make it less scary.”

Online information explaining the testing procedure also can calm young men’s fears. Finger stick or cheek swabs are both options for testing, which teens may not realize. The IMPACT Program at Feinberg created a video that shows young people what it’s like to get an HIV test.

Between June and November 2014, the study enrolled a national sample of 302 gay, bisexual and queer males ages 14 to 18 years into a text messaging-based HIV prevention program (Guy2Guy). Questions about their HIV-testing behaviors were included in the study. The researchers found only 20 percent of the teenage boys had ever been tested for HIV, a rate that is much lower than what other studies have found with adult gay and bisexual men. A 2008 national Centers for Disease Control and Prevention-sponsored study of men who have sex with men found 75 percent of men ages 18 to 19 reported they had been tested for HIV, for example.

Michele Ybarra, an investigator at the Center for Innovative Public Health Research, was the co-principal investigator on the study.

The article is titled “Low Rates of Human Immunodeficiency Virus Testing Among Adolescent Gay, Bisexual, and Queer.”

This study was supported by grant R01MH096660 from the National Institute of Mental Health of the National Institutes of Health.