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Original Investigation
October 22, 2007

Trends in HIV Testing and Differences Between Planned and Actual Testing in the United States, 2000-2005

Author Affiliations

Author Affiliations: Health Inequalities Program, Center for Health Policy (Drs Ostermann, Pence, and Whetten), Department of Community and Family Medicine (Drs Ostermann and Whetten), Terry Sanford Institute of Public Policy (Drs Pence and Whetten), Duke University, Durham, North Carolina; and Westat (Dr Kumar), Rockville, Maryland.

Arch Intern Med. 2007;167(19):2128-2135. doi:10.1001/archinte.167.19.2128

Background  Increasing the rates of human immunodeficiency virus (HIV) testing among groups not traditionally perceived as being at high risk has been advanced as a primary strategy in the effort to combat the HIV epidemic.

Methods  We conducted a pooled cross-sectional analysis of data from 146 868 participants aged 18 to 64 years in the 2000-2005 National Health Interview Surveys to describe longitudinal trends in HIV testing rates in the US population and differences between planned and actual testing across demographic and risk groups. Multivariable logistic models were estimated to assess correlates of perceived risk for HIV infection and planned and actual HIV testing. Difference-in-differences models examine how differences between planned and actual testing varied with demographic characteristics, perceived risk, alcohol consumption, depression, and health behaviors and access.

Results  Rates of HIV testing remained relatively unchanged from 2000 to 2005 (mean rates for lifetime and past year, 37% and 10%, respectively) and varied substantially by sex and race, with female and minority (nonwhite) populations more likely to get tested. Rates were higher in individuals reporting greater risks of HIV infection. However, even among respondents reporting medium or high risks of contracting HIV, less than 25% reported an HIV test in the previous year. Those with a higher perceived risk, more alcohol consumption, and more depressive symptoms had higher rates of both planned and actual testing but also demonstrated the greatest deficit of actual relative to planned testing.

Conclusions  In the United States, HIV testing rates remain low, nationally and in high-risk populations; low rates are likely contributing to a substantial number of undiagnosed cases of HIV. Despite above-average testing rates, populations considered to be at increased risk for HIV infection still demonstrate the need for improved access to and utilization of testing.