Under 5% of U.S. Adults Age 50 or Older Tested for HIV, Despite Guidelines

Although guidelines call for routine opt-out HIV testing of adults at all medical encounters, fewer than 5% of U.S. adults between ages 50 and 64 get tested, according to analysis of the 2010 Behavioral Risk Factor Surveillance System (BRFSS). According to the the 2010 survey, whites were tested significantly less often than other racial or ethnic groups, while people reporting a recent doctor visit proved over twice as likely to receive an HIV test.

As many as 20% of HIV-positive people in the United States remain untested and do not know their HIV status. Because of this high rate, the U.S. Preventive Services Task Force recommends HIV testing at least once for adults under 65 years old and additional tests for people at high risk, or living or working in areas with HIV prevalence of 1% or greater. The Centers for Disease Control and Prevention recommend opt-out HIV screening for all adults up to 65 years old at all medical encounters in areas with an HIV prevalence of at least 0.1%.

To determine HIV testing rates in U.S. adults between 50 and 64 years old, researchers analyzed data from 143,247 respondents to the 2010 BRFSS, which asked whether a respondent had an HIV test in the past 12 months. The investigators divided the sample into three age groups: 50 to 54, 55 to 59 and 60 to 64. They examined six predisposing factors (race/ethnicity, sex, marital status, employment status, educational attainment, and annual household income above or below $20,000), four enabling factors (seeing a physician in the past year, medical costs, health insurance status and having a usual source of care) and one need factor (HIV risk behavior).

Half of the study group was female, about three-quarters were white and 70% had a recent doctor visit. Only 13% of respondents lacked health insurance, and only 11% did not have a usual source of care. Among the 143,247 respondents, 4717 (3.3%) had an HIV test in the past year, including 1864 of 44,918 people 50 to 54 years old (4.1%), 1578 of 48,701 people 55 to 59 years old (3.2%), and 1275 of 49,628 people 60 to 64 years old (2.6%).

Across the three age groups, HIV testing rates were higher among people who reported a recent doctor visit. Multivariable models confirmed higher HIV testing rates across age groups in blacks and Latinos than in whites. Overall, logistic regression analysis determined that men had a twice higher likelihood of HIV testing than women (adjusted odds ratio [aOR] 2.14, 95% confidence interval [CI] 1.92 to 2.39). Compared with married or cohabitating adults, singles proved over twice as likely to get tested for HIV (aOR 2.13, 95% CI 1.89 to 2.41, for divorced/separated/never married; aOR 2.43, 95% CI 1.92 to 3.08, for widowed).

Four other variables raised chances of HIV testing: being unemployed (aOR 1.26, 95% CI 1.11 to 1.43), having an annual household income below $20,000 (aOR 1.48, 95% CI 1.25 to 1.74), seeing a physician in the past year (aOR 2.35, 95% CI 1.99 to 2.77) and reporting an HIV risk behavior in the past year (aOR 3.42, 95% CI 2.61 to 4.49). Compared with people who had more than a high school education, those with only a high school education (aOR 0.74, 95% CI 0.65 to 0.84) or less than a high school education (aOR 0.77, 95% CI 0.61 to 0.96) had about a 25% lower chance of testing.

The researchers observe that, although having a recent physician visit independently boosted the odds of HIV testing, testing rates remained below 5% in people with a recent visit. This finding "suggests that older adults either receive care primarily in very low [HIV] prevalence settings or fail to receive routine opt-out HIV testing when they obtain care in higher-prevalence settings."

Noting that "[o]lder adults tend to underestimate their HIV risk, and few respondents who reported risk behaviors actually tested," the authors propose that "screening may facilitate detection of undiagnosed HIV among those who are unaware of their risks." They stress that "[p]roviders are uniquely suited to promote HIV testing among older adults because members of this age group are receptive to prevention messages delivered by providers."

Mark Mascolini is a freelance writer focused on HIV infection.