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HIV Testing Within At-Risk Populations in the United States and the Reasons for Seeking or Avoiding HIV Testing

January 13, 2003

HIV transmission still occurs in the United States, despite dramatic decreases in AIDS cases since the introduction of HAART. As of 1998, approximately two-thirds of HIV-infected people knew their HIV status, having been tested confidentially. Since then, new CDC initiatives such as Serostastus Approach to Fighting the Epidemic (SAFE) have encouraged testing among high-risk populations and focused prevention efforts on HIV-positive persons.

The current study used the HIV Testing Survey (HITS), a cross-sectional interview study of high-risk individuals, to quantify HIV testing behaviors in high-risk groups, the reasons for seeking testing among those tested, the reasons for not seeking testing among the untested, and attitudes and beliefs about HIV testing among three high-risk groups: MSM recruited from gay bars, street-recruited IDUs, and heterosexual persons recruited from STD clinics. HITS was conducted twice (1995-1996 and 1998-1999), thus enabling the authors to examine differences in testing or reasons for testing in high-risk populations before and after the introduction of HAART.

The researchers confined their analysis to six states common to both HITS-I and HITS-II: Arizona, Colorado, Missouri, New Mexico, Oregon and Texas. Participants were age 18 or older, had lived in the state for a year or more, and provided oral informed consent.

HITS-I had data on 1,599 respondents for final analysis (529 MSM, 527 IDUs and 543 STD clinic attendees). HITS-II had data on 1,711 respondents for final analysis (585 MSM, 563 IDUs and 563 STD clinic attendees). Demographics of respondents in both surveys were similar in terms of sex, age, and racial/ethnic distribution.

In both HITS-I and HITS-II in the six states the authors focused on, 75 percent of high-risk respondents reported at least one previous HIV test. HITS-II (1998-1999) showed a slightly higher percentage of those tested. This finding, coupled with the estimate through 1998 that approximately two-thirds of HIV-positive people know their status, "provide[s] some evidence that current prevention efforts aimed at high-risk populations, of which counseling and testing remain the cornerstones, may be reaching a substantial part of their intended audience," the authors wrote. However, they cautioned, about 20 percent of participants at high risk have either not sought or not been offered HIV testing, and a subset of those untested people do not perceive themselves to be at risk for HIV.

The most commonly cited reason for testing reflected personal motivation (i.e., "to know where one stood") followed by recognition of risk (i.e., "thought exposed through sex or drugs"). Reasons for avoiding testing reflected denial of risk factors (i.e., "unlikely exposed to HIV" or "thought HIV-negative"). "Untested respondents," the authors wrote, "were less likely to believe that medical care can maintain the health of those who are HIV-positive, had a greater level of HIV risk denial, and had less knowledge of HIV risk factors than those who had been tested."

Kellerman and colleagues found a lower proportion of testing among under-25-year-olds in HITS II, suggesting that youths at high risk may not be heeding traditional prevention messages. They also found that, despite myriad prevention efforts targeted to MSM, the largest disparities in HIV perceptions between tested and nontested respondents occurred in that population.

"These findings," they wrote, "in light of reasons for testing and not testing, suggest that efforts to increase testing should focus on individual assessment of risk. ... In terms of tailoring prevention to specific groups, our data suggest that voluntary counseling and testing programs should focus efforts on younger persons (i.e., Back to other CDC news for January 13, 2003

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Adapted from:
Journal of Acquired Immune Deficiency Syndromes
10.01.02; Vol. 31: P.202-210; Scott E. Kellerman; J. Stan Lehman; Amy Lansky; Mark R. Stevens; Frederick M. Hecht; Andrew B. Bindman; Pascale M. Wortley

This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.


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