Background Most data about HIV/STI testing and diagnosis among US men who have sex with men (MSM) comes from urban areas, though the majority of the population resides outside of these areas. Since 2013, the American Men’s Internet Survey (AMIS) has conducted annual nationwide online behavioral surveillance of ≥10,000 US MSM.

Methods Participants age 15+ were recruited through online advertisements. County urban/rural categories were based on National Center for Health Statistics classification. Poisson models using generalized estimating equations tested associations between urban/rural category and HIV testing, STI (syphilis, gonorrhea, chlamydia) testing and STI diagnoses in the past 12 months. All models controlled for survey year, age, race/ethnicity, insurance, HIV status (except model for HIV testing) and recruitment source.

Results From 2013 through 2017, 49,903 completed surveys were collected: 42.4% MSM from urban counties, 20.5% suburban, 28.3% small/medium metro, and 8.8% rural. STI testing was more prevalent in urban counties (50.2%) compared to suburban (37.8%, p<0.0001), small/medium metro (35.6%, p<0.0001) and rural (27.8%, p<0.0001) counties. STI diagnoses were more prevalent in urban counties (13.4%) compared to suburban (8.1%, p<0.0001), small/medium metro 7.5%, p<0.0001) and rural (5.4%, p<0.0001) counties. Among HIV-negative/unknown status MSM, HIV testing was more prevalent among MSM from urban counties (61.9%) compared to suburban (52.3%, p<0.0001), small/medium metro (50.6%, p<0.0001) and rural (43.6%, p<0.0001) counties. Significant trends over time were observed in HIV testing for all counties, while STI testing only increased in urban and small/medium metro counties. STI diagnoses increased significantly in all but rural counties.

Conclusion Urban/rural disparities in HIV/STI testing and STI diagnoses were found in a multi-year national sample of US MSM. These findings likely reflect disparate geographical distribution of healthcare access and resources. If these disparities cannot be adequately addressed in programs that reach underserved areas, nationwide HIV/STI prevention goals for MSM will not likely be met.

Disclosure No significant relationships.