Gay men who live outside major Canadian cities are less likely to get an HIV test than their metropolitan counterparts, according to a survey which also finds that the lower testing rates are likely connected to internalized feelings of homophobia and a reluctance to disclose sexual preferences at a doctor's office. 

The team surveyed 153 people recruited through online dating sites and events in the gay community. The results were that 24 percent of men living in smaller communities had never had an HIV test, compared to the 14 to 17 percent of untested men living in large cities such as Vancouver and Toronto.

According to the Public Health Agency of Canada, gay men represented 53 percent of total HIV infections in 2014, accounting for 39,630 people across the country.

 "This study shows that a lack of feeling accepted appears to not only pose mental health risks, it poses physical health risks," says Susan Holtzman, associate professor of psychology at
University of British Columbia. "The fact that these men are reluctant to tell their doctor about their sexuality is something that requires attention in our healthcare system if we hope to increase the number of people tested for HIV."

Holtzman's study was recently published in the journal AIDS Care.