Factors Associated With HIV Testing Among HIV-Positive and HIV-Negative High-Risk Adolescents: The REACH Study

A recent issue of Pediatrics featured a study focusing on the HIV testing patterns of HIV-positive and HIV-negative high-risk adolescents to determine why, where, and when young people use such testing services.

Methods

Researchers recruited 387 participants from 15 primary healthcare facilities nationwide. In order to be eligible for the study, participants had to have been tested for HIV at least once before the study began. Also, HIV-positive adolescents (N=246) had to have contracted the virus through intravenous drug use or through sexual intercourse. HIV-negative adolescents had to have a history of high-risk behavior that increases the possibility of contracting HIV.

Participant History

Researchers asked participants about their sexual history, including the number of sexual partners they had had, their own sexual orientation, and their age at first intercourse. Male participants also had to answer whether they had ever had male-to-male sexual contact.

Participants also answered questions about their drug and alcohol history, including how often they consumed alcohol and/or marijuana (if at all).

Researchers also administered urinanalysis tests to measure marijuana use.

Researchers used these answers to determine individual participants’ risk levels for contracting HIV.

HIV Testing History

Researchers asked participants how many times they had been tested for HIV before the study, the reasons for which they got tested, and the type of location at which they had the test.

Results

Testing History

• 68.1% of HIV-positive participants and 63.8% of HIV-negative participants had been tested fewer than three times
• 31.9% of HIV-positive participants and 36.2% of HIV-negative participants had been tested three or more times
• 70% of African-American participants, 46.5% of white participants, and 62.9% of “other/mixed ethnicity” participants had been tested fewer than three times
• 30% of African-American participants, 53.5% of white participants, and 37.1% of “other/mixed ethnicity” participants had been tested three or more times

Reasons for Being Tested*

• 73.6% of HIV-positive participants and 43.1% of HIV-negative participants reported being tested for HIV out of fear they had contracted the virus through sexual behavior
• 53.1% of HIV-positive participants and 66.1% of HIV-negative participants reported being tested for HIV based on healthcare providers’ recommendations
• 25.7% of female participants and 30.2% of male participants reported being tested for HIV because of feeling sick

*There is no ethnic breakdown given here because the differences were minimal.

Place of HIV Testing

• 71.4% of HIV-positive participants and 73.6% of HIV-negative participants went to a confidential or anonymous site to be tested for HIV
• 73.5% of female participants, and 63.4% of male participants went to a confidential or anonymous test site to be tested for HIV
• 71.5% of African-American, 75% of white participants, and 72.9% of “other/mixed ethnicity” participants went to a confidential or anonymous test site to be tested for HIV
• 22.1% of HIV positive participants and 21.4% of HIV-negative participants went to a hospital/emergency room to be tested for HIV
• 20.5% of female participants and 26.3% of male participants went to a hospital/emergency room to be tested for HIV
• 22.4% of African-American participants, 20.8% of “other/mixed ethnicity” participants, and 20% of white participants went to a hospital/emergency room to be tested for HIV
• 5.6% of HIV-positive participants and 2.5% of HIV-negative participants were tested when entering the Job Corps or the military
• 4.9% of female participants and 3.5% of male participants were tested for HIV when entering the Job Corps or the military
• 4.6% of African-American participants, 2.5% of white participants, and 5.2% of “other/mixed ethnicity” participants were tested for HIV when entering the Job Corps or the military
• 0.9% of HIV-positive participants and 2.5% of HIV negative participants went to a blood bank to be tested for HIV
• 1.1% of female participants and 2.6% of male participants went to a blood bank to be tested for HIV
• 1.4% of African-American participants, 1.2% of white participants, and 1% of “other/mixed ethnicity” participants went to a blood bank to be tested for HIV

The researchers found that only a few factors were associated with the number of times an adolescent returned for HIV testing. Among the HIV-positive group, feeling sick was the only factor associated with a greater number of tests, indicating that the appearance of symptoms triggered the need for HIV tests. Yet, because the majority of HIV-positive participants in this study were asymptomatic, many did not pursue multiple HIV tests.

The researchers concluded that among the high-risk participants, having used marijuana in the three months preceding the study, having had the same gender partner (male-to-male), and being White was associated with a greater number of tests. The researchers believe that the HIV-negative participants seemed to have more accurately judged their need for HIV testing on the basis of their health risk behaviors than the HIV-positive participants. Consistent with previous studies, the researchers found that the majority of adolescents got tested for HIV because they feared they contracted HIV through sexual activity.

The researchers suggest implementing and encouraging routine HIV testing at primary healthcare centers and clinics for all youth. They suggest that counseling and testing would not only allow individuals to reaffirm their HIV-status, but would permit them to review how they can reduce the risk of getting infected and transmitting infection to others.

For more information: Debra A Murphy, Ph D., et al, “Factors Associated With HIV Testing Among HIV-Positive and HIV-Negative High-Risk Adolescents: The REACH Study, Pediatrics, volume 110, no. 3, September 2002, pp. 36-47.