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Human immunodeficiency virus (HIV) infection is one of the leading causes of morbidity and mortality in the United States. HIV testing, in conjunction with counseling and other preventive services, can reduce the risk for HIV infection and appropriately link infected persons to treatment. To characterize HIV testing by region, state, and sex, CDC analyzed data from the 1996 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicate a high degree of variability in HIV testing throughout the United States.
BRFSS is a state-specific, random-digit-dialed telephone survey of the U.S. population aged ≥18 years. In 1996, all 50 states and the District of Columbia (DC) participated in BRFSS. The 1996 survey included 14 questions about HIV/acquired immunodeficiency syndrome (AIDS)-related knowledge and attitudes and HIV-antibody testing history. The questions were restricted to persons aged <65 years, except in California, where the questions were asked of persons aged <45 years. In 1996, 97,006 persons responded to these questions (state-specific range: 899-3653). Data were weighted by demographic characteristics and by selection probabilities. Confidence intervals were calculated using SUDAAN to account for the complex survey design.
A mean of 42% of persons (range: 26% [South Dakota] to 60% [DC]) answered yes to the question "Have you ever had your blood tested for HIV?" Persons who answered "yes" were asked "What was the main reason you had your last blood test for HIV?" Responses were divided into two categories: those who chose to be tested for personal or health reasons (i.e., voluntarily tested) (responses included: "just to find out if infected," "for routine checkup," "doctor referral," "sex partner referral," "because of pregnancy," or "other"), and those who were tested for other reasons (e.g., military induction, insurance, and employment). A mean of 22% of persons (range: 10% [South Dakota] to 45% [DC]) reported obtaining HIV-antibody tests for voluntary reasons.
The rate of AIDS cases in 1996 was compared with HIV testing percentages in 1996. In general, in states where the AIDS rate was high, HIV testing also tended to be high. For example, DC had the highest AIDS rate and the highest testing percentage; Florida ranked third in both categories. In comparison, rates of overall testing and voluntary testing were lower in the Midwest, where the AIDS rate is low.
A mean of 44% of men reported having ever been tested for HIV (range: 28% [South Dakota] to 62% [DC]) (Table 1). A mean of 40% of women reported having ever been tested for HIV (range: 23% [North Dakota] to 57% [DC]). In 45 states and DC, a greater percentage of men reported ever being tested for HIV than women. The states with the greatest difference by sex of ever being tested for HIV were North Dakota (11%), Hawaii (10%), and New York (9%). The states with the smallest differences were Alaska, Delaware (both 0.5%), and Texas (0.6%).
A mean of 20% of men reported that their most recent HIV test was voluntary (range: 8% [South Dakota] to 46% [DC]) (Table 1). A mean of 25% of women reported that their most recent HIV test was voluntary (range: 12% [North Dakota] to 45% [DC]). In 49 states, a greater percentage of women reported being voluntarily tested than men. The sex-specific difference in reports of being voluntarily tested ranged from 0.1% in New York and Indiana to 13% in California.
J Cook, MBA, Alabama; P Owen, Alaska; B Bender, MBA, Arizona; J Senner, PhD, Arkansas; B Davis, PhD, California; M Leff, MSPH, Colorado; M Adams, MPH, Connecticut; F Breukelman, Delaware; C Mitchell, District of Columbia; S Hoecherl, Florida; L Martin, MPH, Georgia; AT Onaka, PhD, Hawaii; J Aydelotte, Idaho; B Steiner, MS, Illinois; K Horvath, Indiana; A Wineski, Iowa; M Perry, Kansas; K Asher, Kentucky; R Jiles, PhD, Louisiana; D Maines, Maine; A Weinstein, MA, Maryland; D Brooks, MPH, Massachusetts; H McGee, MPH, Michigan; N Salem, PhD, Minnesota; D Johnson, Mississippi; T Murayi, PhD, Missouri; P Feigley, PhD, Montana; M Metroka, Nebraska; E DeJan, MPH, Nevada; L Powers, MA, New Hampshire; G Boeselager, MS, New Jersey; W Honey, MPH, New Mexico; TA Melnik, DrPH, New York; K Passaro, PhD, North Carolina; J Kaske, MPH, North Dakota; P Pullen, Ohio; N Hann, MPH, Oklahoma; J Grant-Worley, MS, Oregon; L Mann, Pennsylvania; J Hesser, PhD, Rhode Island; D Shepard, South Carolina; M Gildemaster, South Dakota; D Ridings, Tennessee; K Condon, Texas; R Giles, Utah; C Roe, MS, Vermont; L Redman, MPH, Virginia; K Wynkoop-Simmons, PhD, Washington; F King, West Virginia; P Imm, MS, Wisconsin; M Futa, MA, Wyoming. Behavioral Risk Factor Surveillance System, Behavioral Surveillance Br, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.
The findings in this report document a high degree of state-specific variability in self-reported HIV-antibody tests in the United States. Previous reports suggest this variability probably represents state-specific differences in such factors as prevalence of HIV infection and the activities of HIV-prevention and education programs.1
The success of a health-promotion program depends on the level of participation of clients. Although HIV testing and counseling does not affect behavior change similarly across all population groups, in general, persons who voluntarily receive HIV testing are more likely to undergo counseling and modify their behaviors than those who receive testing for other reasons.2 As a result, tracking overall testing rates and voluntary testing rates can help target health-promotion efforts.
The findings in this report are subject to at least two limitations. First, because BRFSS excluded persons without telephones, some persons at high risk for HIV infection probably were excluded. Second, because the BRFSS relies on self-reported data, some bias is expected.
HIV testing can help reach at-risk persons with counseling and other prevention services and link infected persons with needed health-care services. General population surveys, such as BRFSS, provide data to assess the use of HIV testing services across geographical areas. However, not all persons need to be tested for HIV. CDC recommends HIV counseling and testing services for persons with specific risk factors for HIV infection and in specific screening settings (e.g., tissue donation and pregnancy). Prevention programs should be structured to increase the proportion of at-risk persons who receive HIV-testing services.
HIV Testing— United States, 1996. JAMA. 1999;281(8):697–698. doi:10.1001/jama.281.8.697-JWR0224-3-1