Predictors of human immunodeficiency virus counseling and testing among sexually transmitted disease clinic patients

Willingness and Barriers to Voluntary Counselling and Testing Among Self-Perceived Healthy Adults in Tanzania

Background:

Despite the ongoing efforts to promote HIV testing, the majority of adults in Tanzania remain untested, and many remain unwilling to know their HIV status. Understanding the underlying reasons for this unwillingness to test and know one's status will support the development of targeted interventions to promote the uptake of HIV testing. This paper explores the willingness of and barriers faced by self-perceived healthy individuals to test for HIV in selected districts of Tanzania.

Methods:

A cross-sectional survey was conducted in urban and rural wards between October 2011 and March 2012. Structured questionnaires with closed- and open-ended questions were administered to heads of randomly selected households. Information collected included socioeconomic, demographics, rural/urban backgrounds and the perceived reasons which hinder household heads/members to access and utilise HIV-testing services. Regression analysis was conducted to assess the relationship between the same factors and participants' willingness to go for an HIV test in the near future.

Results:

There were 1,429 respondents from randomly selected households interviewed, and out of these, 57.1% were women, and 42.9% were men. The mean age of all respondents was 33.6 years; men were slightly older (mean age, 37 years) than women (mean age, 34 years). Almost one-third (n=433, 30.3%) of the respondents reported having ever tested for HIV, of whom 294 (61.8%) were women, and 139 (38.2%) were men. Being educated to at least the primary school level, being an urban resident, and being female increased the probability of HIV testing by 1.7% (P<.001), 1.3% (P<.005) and 0.2% (P<.005) respectively. Further, for each year, one's age increased the probability of positive future intentions to test for HIV increased by 0.4 % (P<.005). Education, residence and marital status were not significantly associated with future willingness to test. Fear of being stigmatised and discriminated was observed to be one of the important barriers for HIV testing among those who had never tested and those who were unwilling to test in the future.

Conclusion:

In urban areas, knowledge of the benefits of HIV testing is higher than in rural areas. Overall stigma remains the most salient barrier to HIV testing and interventions that address this, and other structural drivers for stigma need to be addressed in order for people's willingness to test to increase. Finally, health systems need to be strengthened to further encourage testing and be ready to provide quality and non-discriminatory services once people's willingness to test becomes apparent.

Relating HIV testing patterns in Poland to risky and protective behaviour

The aim of the study was to understand HIV testing patterns needed to improve access to early HIV diagnosis, and to investigate the spread of the virus in different populations. We examined prior testing history of individuals presenting for an HIV test across all 30 voluntary testing and counselling sites in Poland, 2008-2010 to determine factors associated with the testing rate using zero-truncated Poisson regression. Of 2397 persons presenting for an HIV test, 25 (1%) were HIV positive and 470 (19.6%) were repeat testers. The proportion of repeat testers was higher among men who have sex with men (MSM) at 37% (90/246), and people who inject drugs (PWID) at 32% (21/65). Higher testing rate was independently associated with exposure category (testing rate ratio, RR for MSM = 2.0, 95% CI 1.6-2.6, and 1.6, 0.9-2.6 for PWID), >5 sex partners (1.9, 1.4-2.7), high-risk partner (1.3, 1.1-1.6), urban residence (2.1, 1.3-3.5) and higher education attainment (1.1, 1.0-1.5). Inconsistent condom use with casual partners and sex under the influence of alcohol were associated with lower testing rates. There is a need to increase HIV testing uptake in Poland, especially among the rural population. Despite testing rates being higher among populations with higher risk of exposure to HIV (MSM and PWID), they still remain low, indicating the existence of barriers to testing.

HIV Testing and Diagnosis Rates in Kiev, Ukraine: April 2013-March 2014

Objective

Data from Ukraine on risk factors for HIV acquisition are limited. We describe the characteristics of individuals testing for HIV in the main testing centres of the Ukrainian capital Kiev, including HIV risk factors, testing rates, and positivity rates.

Methods

As part of a larger study to estimate HIV incidence within Kiev City, we included questions on possible risk factors for HIV acquisition and testing history to existing systems in 4 infectious disease clinics. Data were provided by the person requesting an HIV test using a handheld electronic tablet. All persons (≥16yrs) presenting for an HIV test April 2013–March 2014 were included. Rates per 100,000 were calculated using region-specific denominators for Kiev.

Results

During the study period 6370 individuals tested for HIV, equivalent to a testing rate of 293.2 per 100,000. Of these, 467 (7.8%) were HIV-positive, with the highest proportion positive among 31–35 year olds (11.2%), males (9.4%), people who inject drugs (PWID) (17.9%) and men who have sex with men (MSM) (24.1%). Using published population size estimates of MSM, diagnosis rates for MSM ranged from 490.6to 1548.3/100,000. A higher proportion of heterosexual women compared to heterosexual men reported contact with PWID, (16% vs. 4.7%) suggesting a bridging in risk between PWID and their sexual partners.

Conclusion

Collection of HIV risk factor information in Kiev, essential for the purposes of developing effective HIV prevention and response tools, is feasible. The high percentage of MSM among those testing positive for HIV, may indicate a significant level of undisclosed sex between men in national figures.

Factors associated with self-reported HIV testing among men in Uganda

This study examined rates and predictors of self-reported HIV testing and willingness to test among married men aged 15-59 in Uganda. The data are nationally representative and drawn from the 2000-01 Uganda Demographic and Health Survey. The results of multiple regression analyses indicate that knowledge about AIDS, a history of paying for sex, spousal communication about HIV prevention, secondary or higher education, household wealth, and neighbourhood knowledge of a test site are associated with an increased likelihood of HIV testing. The higher the frequency of injection use in the past 3 months and the greater the level of interest in learning how to help one's partner have a safe pregnancy, the higher was the likelihood of willingness to test for HIV. Findings suggest that voluntary counselling and testing programmes need to target older married men aged 30-59 and expand services to the Northern region, where previously untested men indicated significantly higher desires of HIV testing.

Frequent HIV testing among participants of a routine HIV testing program

Massachusetts developed a routine HIV testing program in four sites from January-September 2002. Of the 2,502 patients tested, 453 (18.1%) reported ≥2 HIV tests within the prior three years. In multivariate analyses, frequent HIV testing was associated with younger age (18-30 years, OR = 1.42), a history of injection drug use (OR = 6.35), and men who had sex with men (OR = 3.49). Participants who reported multiple sexual partners (OR = 2.17) and high risk sexual behavior (OR = 2.02) were significantly more likely to have had a prior HIV test. Patients whose HIV risk was unknown had the highest association with frequent testing (OR = 13.18). Because characteristics of frequent HIV testers may inform behavioral interventions, there is a need to understand the motivation for repeatedly accessing HIV testing services.

Perceived everyday racism, residential segregation, and HIV testing among patients at a sexually transmitted disease clinic

OBJECTIVES

More than one quarter of HIV-infected people are undiagnosed and therefore unaware of their HIV-positive status. Blacks are disproportionately infected. Although perceived racism influences their attitudes toward HIV prevention, how racism influences their behaviors is unknown. We sought to determine whether perceiving everyday racism and racial segregation influence Black HIV testing behavior.

METHODS

This was a clinic-based, multilevel study in a North Carolina city. Eligibility was limited to Blacks (N = 373) seeking sexually transmitted disease diagnosis or screening. We collected survey data, block group characteristics, and lab-confirmed HIV testing behavior. We estimated associations using logistic regression with generalized estimating equations.

RESULTS

More than 90% of the sample perceived racism, which was associated with higher odds of HIV testing (odds ratio = 1.64; 95% confidence interval = 1.07, 2.52), after control for residential segregation, and other covariates. Neither patient satisfaction nor mechanisms for coping with stress explained the association.

CONCLUSIONS

Perceiving everyday racism is not inherently detrimental. Perceived racism may improve odds of early detection of HIV infection in this high-risk population. How segregation influences HIV testing behavior warrants further research.

Improving HIV rapid testing rates among STD clinic patients: a randomized controlled trial

OBJECTIVE

The Centers for Disease Control and Prevention recommends that HIV testing be a standard part of medical care; however, testing is voluntary and some patients decline. We evaluated 2 brief interventions to promote rapid HIV testing among STD clinic patients who initially declined testing.

METHOD

Using a randomized controlled trial, patients either viewed an educational digital video disc (DVD) or participated in stage-based behavioral counseling (SBC) provided by a nurse. Sixty clients presenting for care at a STD clinic who initially declined HIV testing at registration and during risk behavior screening participated in the study.

RESULTS

The primary outcome was whether patients agreed to be tested for HIV. The secondary outcomes included attitudes, knowledge, and stage-of-change regarding HIV testing. Patients receiving both interventions improved their attitudes and knowledge about testing (ps < .01). Patients receiving SBC agreed to testing more often (45%) than did patients who viewed the DVD (19%; p < .05).

CONCLUSIONS

Brief interventions can increase rapid HIV testing acceptance among patients who are reluctant to be tested; counseling guided by behavioral science theory is more effective than a well-designed information-based intervention.

HIV risk factors reported by two samples of male bathhouse attendees in Los Angeles, California, 2001-2002

BACKGROUND

We aimed to describe the use of voluntary HIV counseling and testing services, risk behaviors, and risk factors for unprotected anal sex (UAS) among men who have sex with men (MSM) who attended a bathhouse in Los Angeles during 2001-2002.

METHODS

Using 2 cross-sectional study samples, we compared (in order below) 458 of 640 MSM who used voluntary HIV counseling and testing in the bathhouse with 398 MSM surveyed upon exit. Within each group, logistic regression identified factors associated with UAS at their most recent bathhouse visit.

RESULTS

Of 640 MSM, 71 (11%) tested HIV-positive for the first time. Of the 50 HIV-positive MSM who completed a survey, 50% tested because of the convenient services. Similar proportions of MSM in both survey samples reported UAS (7%-8%) during their recent bathhouse visit. Risk factors associated with UAS in both survey samples were UAS with men outside the bathhouse and greater numbers of partners within the bathhouse.

CONCLUSIONS

Comprehensive prevention services provided within bathhouses may reduce undiagnosed HIV infections among MSM, and targeting HIV prevention at the bathhouse may reduce risks with partners both inside and outside the bathhouse.

Are women from high-risk ethnic minority groups more likely to decline antenatal HIV screening?

Eight new cases of human immunodeficiency virus (HIV) were diagnosed in the antenatal population of Milton Keynes within the first two years of our 'opt-out' antenatal testing scheme; the majority (6/8) occurred in women of black African origin. Since it is suggested that individuals from high-risk groups are more likely to decline HIV testing, we were concerned that women from this high-risk ethnic group might not be accepting testing. Such a situation would increase the risk of undiagnosed HIV-positive women delivering at Milton Keynes and undermine the potential benefits of the screening programme. Retrospective review of pregnant women delivering in our area over six months was performed. Hospital obstetric and microbiology databases were analysed for results of HIV screening and ethnic origin of patients. A total of 1586 women delivered during the study period. Among the black African women 13/158 (8.2%) declined screening, compared with 120/1214 (9.8%) and 15/153 (9.8%) of white and Asian women, respectively. The high uptake of testing across all groups suggests that the policy of offering and recommending HIV screening to all women is being appropriately implemented. Black African women were more likely to have undergone screening than white or Asian women, although the differences were not statistically significant.

Determinants of late disease-stage presentation at diagnosis of HIV infection in Venezuela: a case-case comparison

Background

Although Venezuela has a National Human Immunodeficiency Virus (HIV) Program offering free diagnosis and treatment, 41% of patients present for diagnosis at a later disease-stage, indicating that access to care may still be limited. Our study aimed to identify factors influencing delay in presenting for HIV-diagnosis using a case-case comparison. A cross-sectional survey was performed at the Regional HIV Reference Centre (CAI), Carabobo Region, Venezuela. Between May 2005 and October 2006 225 patients diagnosed with HIV at CAI were included and demographic, behavioural and medical characteristics collected from medical files. Socio-economic and behavioural factors were obtained from 129 eligible subjects through interviews. "Late presentation" at diagnosis was defined as patients classified with disease-stage B or C according to the 1993 Centers for Disease Control and Prevention (Atlanta, USA) classification, and "early presentation" defined as diagnosis in disease-stage A.

Results

Of 225 subjects, 91 (40%) were defined as late presenters. A similar proportion (51/129) was obtained in the interviewed sub-sample. Older age (>30 years), male heterosexuality, lower socio-economic status, perceiving ones partner to be faithful and living ≥ 25 km from the CAI were positively associated with late diagnosis in a multivariate model. Females were less likely to present late than heterosexual males (odds ratio = 0.23, P = 0.06). The main barriers to HIV testing were low knowledge of HIV/AIDS, lack of awareness of the free HIV program, lack of perceived risk of HIV-infection, fear for HIV-related stigma, fear for lack of confidentiality at testing site and logistic barriers.

Conclusion

Despite the free Venezuelan HIV Program, poverty and barriers related to lack of knowledge and awareness of both HIV and the Program itself were important determinants in late presentation at HIV diagnosis. This study also indicates that women; heterosexual, bisexual and homosexual men might have different pathways to testing and different factors related to late presentation in each subgroup. Efforts must be directed to i) increase awareness of HIV/AIDS and the Program and ii) the identification of specific factors associated with delay in HIV diagnosis per subgroup, to help develop targeted public health interventions improving early diagnosis and prognosis of people living with HIV/AIDS in Venezuela and elsewhere.

Factors associated with delayed initiation of HIV medical care among infected persons attending a southern HIV/AIDS clinic

BACKGROUND

Despite the proven benefits conferred by early human immunodeficiency virus (HIV) diagnosis and presentation to care, delays in HIV medical care are common; these delays are not fully understood, especially in the southern United States.

METHODS

We evaluated the extent of, and characteristics associated with, delayed presentation to HIV care among 1,209 patients at an HIV/AIDS Outpatient Clinic in Birmingham, Alabama between 1996 and 2005.

RESULTS

Two out of five (41.2%) patients first engaged care only after they had progressed to CDC-defined AIDS. Among these, 53.6% were diagnosed with HIV in the year preceding entry to care. Recent presentation (2002 - 2005), male sex, age > or = 25, Medicare or Medicaid insurance coverage, and presentation within six months of HIV diagnosis were independently associated with initiating care after progression to AIDS.

CONCLUSIONS

A high proportion of patients entered clinical care after experiencing substantial disease progression. Interventions that effectively improve the timing of HIV diagnosis and presentation to care are needed.

Decisional balance, perceived risk and HIV testing practices

Improving our understanding of how individuals decide to take an HIV test is essential for designing effective programs to increase testing. This paper assesses the relationship of decisional balance and perceived risk to HIV testing history in a cross-sectional community sample of 1523 HIV-negative men and women at risk due to drug use or sexual behavior. We developed scales to measure perceived advantages (pros) and perceived disadvantages (cons) of taking an HIV test and assessed their content using factor analysis. Perceived risk was highly related to the pros and cons scales. Multivariate analyses revealed that the pros scale had positive associations with having ever tested and the number of tests taken, while the cons scale had negative associations with these testing measures. Perceived risk was not related to testing practices. These results suggest that interventions to increase HIV testing need to address anticipated positive and negative outcomes of getting tested.

Delayed access to HIV diagnosis and care: Special concerns for the Southern United States

HIV diagnosis and presentation to appropriate medical care during early stages of disease has substantial clinical and public health benefits. However, a large proportion of HIV-infected Americans experience diagnosis and treatment related delays. Prior research evaluating barriers to early HIV diagnosis and care presentation have been published primarily from large East and West coast urban centers. Therefore, predictors of delayed presentation to HIV care identified by these studies may not be generalizable to the South where infected persons are increasingly non-white, female, poor, non-urban, and possibly exposed to HIV heterosexually. We review here the benefits conferred by HIV care, descriptive epidemiology of delayed HIV diagnosis and care, and potential barriers to early medical care with special reference to conditions prevalent in the South.

Predictors of repeat testing and HIV seroconversion in a sexually transmitted disease clinic population

OBJECTIVE

This study assessed the extent of and characteristics associated with repeat HIV testing in persons presenting to a sexually transmitted disease (STD) clinic.

METHODS

The study population included all 101 newly diagnosed HIV-infected subjects and 411 matched HIV-uninfected subjects identified over a 5-year period in a publicly funded STD clinic in the southeastern United States.

RESULTS

Of the 508 subjects (99%) with available records, 160 (32%) had tested previously. Age, race, return for posttest counseling, and the client's stated reason for coming to the clinic were associated with repeat testing. Among the 160 subjects who had tested previously, self-identifying as a man who has sex with men or having a history of incarceration was strongly associated with HIV seroconversion (adjusted odds ratio [OR], 51.82; 95% confidence interval [CI], 9.10-295.13; adjusted OR, 83.98, 95% CI, 17.26-408.69, respectively). Presenting for STD-related reasons (STD symptoms or requesting an STD check) had a negative association with HIV seroconversion (adjusted OR, 0.07; 95% CI, 0.01-0.90) compared with presenting for the sole purpose of requesting an HIV test.

CONCLUSIONS

Repeat HIV testing is common among patients receiving services at an STD clinic. The role of repeat testing in HIV prevention efforts is complex and poorly understood. Results from this study could be used to identify and target those testing previously at highest risk for contracting HIV for risk-reduction interventions.

Is HIV/sexually transmitted disease prevention counseling effective among vulnerable populations?: a subset analysis of data collected for a randomized, controlled trial evaluating counseling efficacy (Project RESPECT)

OBJECTIVE

The objective of this study was to evaluate counseling efficacy among high-risk groups.

STUDY

We conducted a subset analysis of data collected from July 1993 through September 1996 during a randomized, controlled trial (Project RESPECT). Participants (n = 4328) from 5 public U.S. sexually transmitted disease (STD) clinics were assigned to enhanced counseling, brief counseling, or educational messages. For 9 subgroups (sex, age, city, education, prior HIV test, STD at enrollment, race/ethnicity, injection drug use, exchanging sex for money/drugs), we compared STD outcomes for those assigned either type of counseling with STD outcomes for those assigned educational messages.

RESULTS

After 12 months, all subgroups assigned counseling (brief or enhanced) had fewer STDs than those assigned educational messages. STD incidence was similar for most subgroups assigned enhanced or brief counseling. All subgroups had an appreciable number of STDs prevented per 100 persons counseled, especially adolescents (9.4 per 100) and persons with STD at enrollment (8.4 per 100).

CONCLUSIONS

HIV/STD prevention counseling (brief or enhanced counseling) resulted in fewer STDs than educational messages for all subgroups of STD clinic clients, including high-risk groups such as adolescents and persons with STDs at enrollment.

To test or not to test: are Hispanic men at highest risk for HIV getting tested?

This study examined how HIV testing history and future testing intentions were related to sexual risk and perceptions of risk in a community sample of 1,052 Hispanic men. This sample is noteworthy in its diverse representation of Hispanics, its high ratio of participants born outside the USA, and its inclusion of heterosexuals and men who have sex with men (MSM). We used area-based sampling to recruit participants at public venues. Data were collected via anonymous, structured interviews from December 1999 to February 2001. Lifetime testing rates were high (76%), but only 45% had been tested in the last 12 months. Results indicate that men at highest risk-those who were MSM, had more partners and had STDs-were more likely to have been tested, and to have been tested recently, than men with lower risk. Being MSM and having been previously tested predicted future testing intentions. Inconsistent condom users with more than five partners were less likely to intend to be tested than men with more than five partners who used condoms consistently. Studying men who have successfully routinized HIV prevention practices (including testing) will assist in the development of interventions for those who remain at risk.

Changing sexual behavior among gay male repeat testers for HIV: a randomized, controlled trial of a single-session intervention

CONTEXT

High-risk sexual behavior is increasingly prevalent among men who have sex with men (MSM) and among men with a history of repeat testing for HIV.

OBJECTIVES

The study assessed whether one counseling intervention session focusing on self-justifications (thoughts, attitudes, or beliefs that allow the participant to engage in high-risk sexual behaviors) at most recent unprotected anal intercourse (UAI) is effective in reducing future high-risk behaviors among HIV-negative men.

DESIGN, SETTING, AND PARTICIPANTS

A randomized, controlled, counseling intervention trial was conducted at an anonymous testing site in San Francisco, California, between May 1997 and January 2000. Participants were 248 MSM with a history of at least one previous negative HIV test result and self-reported UAI (receptive or insertive) in the previous 12 months with partners of unknown or discordant HIV status. Two intervention groups received standard HIV test counseling plus a cognitive-behavioral intervention, and two control groups received only standard HIV test counseling. Follow-up evaluation was at 6 and 12 months.

MAIN OUTCOME MEASURE

Number of episodes of UAI with nonprimary partners (of unknown or discordant HIV status) in the 90 days preceding the interview was measured via self-report during face-to-face interview.

RESULTS

A novel counseling intervention focusing on self-justifications significantly decreased the proportion of participants reporting UAI with nonprimary partners of unknown or discordant HIV status at 6 and 12 months (from 66% to 21% at 6 months and to 26% at 12 months, p =.002; p <.001) as compared with a control group when added to standard client-centered HIV counseling and testing.

CONCLUSIONS

A specific, single-session counseling intervention focusing on a reevaluation of a person's self-justifications operant during a recent occasion of high-risk behavior may prove useful in decreasing individual risk behavior and thus limiting community-level HIV transmission.

'Getting checked and having the test': drug injectors' perceptions of HIV testing - findings from qualitative research conducted in England

If HIV and AIDS policy initiatives are to be successful in tackling the spread of infection it is important to understand more about the ways in which people perceive HIV and AIDS. HIV testing is a policy initiative that will work when people take the test and make appropriate changes to their behaviour as a result. This paper is based on a study that used in-depth interviews and a vignette with drug injectors to explore drug injectors' perceptions of HIV risk outside and inside prison. HIV testing was an integral part of drug injectors' perceptions of risk. Three main themes emerged from the analysis of these data: first, reasons for not taking a test; second, reasons for taking a test; and third, the impact of testing upon subsequent behaviour. The paper ends with a summary and conclusions highlighting implications for future research and policy development.

Motives for HIV testing among drug users: an analysis of gender differences

This article examines gender differences related to why 66 injection and noninjection drug users tested for HIV. Study participants from three northern California counties underwent an open-ended qualitative interview covering: access to HIV testing, the meaning of HIV testing and test results, drug and sexual risk behaviors, and behavior changes associated with HIV testing, as well as a brief quantitative survey. The responses were analyzed using the following categories: (a) financial incentives for testing, (b) concerns related to family members and significant others, and (c) personal anxieties due to lack of knowledge of HIV status. Analyses showed that gender differences exist regarding reasons for HIV testing. The most significant finding was that women were motivated to test with regard to concerns related to family and significant others in their life more so than men, particularly during pregnancy. The impetus to test for many individuals was dependent on a social setting, such as jail, hospital, or drug rehabilitation program. Further research examining the motivational factors why drug users test for HIV can provide valuable information for outreach and marketing of HIV counseling-and-testing services.

HIV risk behavior and HIV testing: a comparison of rates and associated factors among homeless and runaway adolescents in two cities

This study examined differences in self-reported rates and predictors of HIV testing between homeless and runaway youths in San Diego (N = 1,102) and Los Angeles (N = 1,167). Youths aged 13-23 were recruited from agency and street sites using a stratified probability sampling design. Interviewers administered a structured survey instrument lasting 20 minutes, which assessed youths' involvement in HIV risk-related sexual and drug-use behaviors, contact with outreach workers, and other variables. Significantly more Los Angeles youths (78%) reported testing than did San Diego youths (52%; p < .001). Multivariable analyses controlling for risk behaviors, knowing someone with HIV, and contact with outreach workers indicated that the higher rates of these factors in Los Angeles did not account for the difference in testing rates between the cities. Youths in Los Angeles were still 1.85 times as likely to be tested as San Diego youths (p < .001), possibly a result of differing normative behavior and accessibility of testing services.

Effective detection of HIV

Biomedical advances, new HIV testing technologies, and policy shifts in the last 15 years have created substantial new challenges and opportunities for service providers, policy makers, and researchers regarding broad scale identification of HIV-seropositive persons. Effective HIV testing will be achieved when we: (1) increase the number of high-risk persons tested; (2) decrease the time from HIV infection to detection; (3) increase testing acceptability; (4) increase the proportion of individuals tested who receive their results; and (5) increase the proportion of individuals tested seropositive who are linked to care. Strategies to enhance effectiveness include implementing new testing technologies and delivery modalities; expanding access to client-controlled testing; targeting providers' knowledge, attitudes, and behaviors regarding HIV testing; mainstreaming HIV testing as routine clinical care; targeting persons who engage in high-risk behaviors and those in high-risk groups; and implementing a national behavioral surveillance system. Addressing these challenges will improve HIV detection in the United States, which is vital to both HIV prevention and treatment.

High-risk sexual behavior in Los Angeles: who receives testing for HIV?

No recent population-based data on HIV testing in people with high-risk sexual behavior are available. We sought predictors of testing using data from the 1997 Los Angeles County Health Survey, a random-digit telephone survey of 8004 county households. An estimated 2.3 million (35.5%) adults were tested for HIV in the past 2 years and approximately 370,000 (5.6%) engaged in high-risk sexual behavior (defined as having > or =2 partners in the past 12 months and not always using condoms). Among high-risk persons, an estimated 46% of heterosexual men, 56% of heterosexual women, and 72% of men who had sex with men (MSM) were tested for HIV. In a multivariable model of high-risk people, both heterosexual men (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.16-0.61) and women (OR, 0.41; 95% CI, 0.19-0.87) had significantly lower proportions of testing than MSM. Although African Americans and Hispanics had significantly higher testing proportions than whites overall among all county residents, those reporting high-risk sexual behavior did not test at higher proportions. We conclude that the proportion of adults with high-risk sexual behavior tested for HIV is higher than almost a decade ago. However, testing among this group remains suboptimal. Future public health campaigns should intensify efforts to encourage HIV testing among this population.

Risk assessment to improve targeting of HIV counseling and testing services for STD clinic patients

BACKGROUND AND OBJECTIVE

To determine whether self-administered risk assessment could improve targeting of HIV counseling and testing in an STD clinic.

STUDY DESIGN

Computerized records from the Prince George's County, Maryland, STD clinic from 1993 through 1996 were used to develop and test models for predicting a positive HIV test. In 1996, a self-administered risk assessment was compared with a counselor's risk assessment of the same patient.

RESULTS

Testing the 10% of patients at highest risk would identify 39% of those who were HIV-positive; testing 70% of the patients could identify 92% of those who were HIV-positive. In 1996, 2,288 patients completed the self-administered HIV risk assessment. The same number of HIV-positive persons (7 [28%]) were identified using either self-assessment or face-to-face interview.

CONCLUSIONS

Selectively offering voluntary HIV testing based on risk assessment would not be useful because it would miss many infected persons. If prevention counseling cannot be offered to everyone, it could be targeted to those who report a risk by self-assessment.

Failure to learn human immunodeficiency virus test results in Los Angeles public sexually transmitted disease clinics

BACKGROUND

Early human immunodeficiency virus (HIV) defection is essential for initiating treatment and partner-notification activities. Sexually transmitted disease (STD) clinic attendees are at high risk for infection and should be made aware of their HIV status.

GOAL

To determine the characteristics associated with not receiving an HIV test result in an STD clinic setting.

STUDY DESIGN

Confidential HIV testing was offered to 6,705 persons attending four public STD clinics in Los Angeles who submitted blood for syphilis serology and were tested for HIV antibody in an unlinked HIV serosurvey. Human immunodeficiency virus test results and return status were anonymously linked to other risk information.

RESULTS

Only one-third of attendees were tested and given their results. Those testing HIV positive in the anonymous survey and those requesting HIV testing were most likely to receive a test result (i.e., 41% and 49%, respectively). Those solely requesting an STD examination, repeat testers, and African-Americans were least likely to receive a result (i.e., 32%, 30%, and 26%, respectively).

CONCLUSIONS

Most STD clinic patients fail to receive an HIV test result. Other strategies, such as rapid HIV testing, are needed to increase participation and receipt of HIV test results in this high-risk population.