HIV antibody testing among those at risk for infection. The National AIDS Behavioral Surveys.

Center for AIDS Prevention Studies, Department of Medicine, San Francisco, CA 94105.
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 11/1993; 270(13):1576-80.
Source: PubMed

ABSTRACT To determine the prevalence of testing for human immunodeficiency virus (HIV) antibody among adults with various risk factors for infection, particularly those residing in large metropolitan areas where the bulk of cases of acquired immunodeficiency syndrome (AIDS) have occurred.
A nationwide, population-based telephone survey eliciting testing, sexual, and injection drug use histories.
A total of 2673 randomly chosen US residents and 8263 randomly chosen residents of 23 metropolitan areas containing 64% of reported cases of AIDS.
Testing for HIV antibody.
Overall, rates of individuals ever tested were only slightly higher in the urban areas (23%) than in the nation as a whole (21%). Testing frequencies were low among all risk groups (less than 40%), except men engaging in same-sex sexual activity (60%) and male and female injection drug users (46% and 73%, respectively). The low rate of testing (35%) among the largest risk group, heterosexual men and women engaging in unprotected sexual intercourse with multiple partners, was particularly worrisome.
To encourage antibody testing among the many at risk for infection who have not yet been tested, promotional campaigns should explain the universal susceptibility to infection among those at risk, and the availability of prophylactic medical therapies and social support services to persons who are HIV-seropositive. As there were comparable levels of risk-taking behavior among subjects in both samples, these campaigns must be designed to reach all segments of the population.

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    ABSTRACT: This study determined the overall prevalence of HIV testing within a community sample of heterosexual men and women at high risk for HIV infection, and analysed the gender-specific individual- and structural-level barriers and facilitators to testing. Data were collected through 1,643 personal interviews conducted in Philadelphia between 1999 and 2000. Overall, 79.4% of participants had ever taken an HIV test; women were significantly more likely to have tested than were men. Among the individual-level factors we examined, very few, including sexual and drug-using risk behaviours, were significantly associated with an increased likelihood of ever being tested for HIV. Structural-level factors were important correlates of HIV testing for both women and men. Results of this study indicate that there are gender-based similarities and differences in the correlates of testing, and that efforts to increase HIV testing must consider how structural factors, including access to health care, may deter or facilitate opportunities for HIV testing. In particular, efforts to improve the uptake of HIV testing by heterosexual men at high risk should focus on improving men's access to, and utilization of, routine health care.
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    ABSTRACT: This paper assesses consistency in self-reports of human immunodeficiency virus testing using two waves of longitudinal data from a large, national probability survey, the National AIDS Behavioral Survey. Of those reporting at Wave I that they had been tested for reasons other than blood donation, 18 percent reported at Wave 2 that they had never been tested. Of those reporting at Wave I that they had been tested when they donated blood, 29 percent reported at Wave 2 that they had never been tested. Inconsistent responses may be due to poor recall and to high self-presentation bias, that is, a desire to provide socially acceptable answers. Poor recall may be exacerbated by passive conditions such as blood donation. The authors conclude with recommendations for reducing measurement error in surveys of testing behavior.
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    ABSTRACT: Objectives: To evaluate factors that predict HIV testing using the model of health care utilisation as its conceptual framework and to analyse some of the factors that encourage or inhibit seeking an HIV test in this population. M e t h o d : A cross sectional questionnaire study in two G e n i t o -U r i n a ry Medicine (GUM) clinics in central Scotland. A final sample of 195 re p resented a 91% response rate. Participants were categorised by their HIV testing status (already tested, planning to be tested, no intention to seek testing). Results: The 'already tested' and 'planning to be tested' g roups were combined as there were no significant d i ff e rences on re p o rted risk behaviours. Analysis there f o re c o m p a red two groups those 'testing' (n = 66) and 'not testing' (n = 129). 67% of those n o t tested for HIV re p o rted at least one HIV risk factor. Perceived risk was the strongest predictor of HIV testing using our model. P e rception of risk and actual risk were not corre l a t e d . Those not seeking testing endorsed less benefits of testing and more denial of the need to be tested. Same day testing and testing without an appointment were endorsed as factors to promote testing. C o n c l u s i o n : To encourage people who have high risk factors to access HIV testing, programmes should: (1) highlight the benefits of testing which would be lost if people do not test, eg. effective drug treatments (2) i n c rease the range of HIV testing services available (eg. same day testing). Furt h e rm o re, studies to determine the main predictors of perceived risk are needed if we are to increase testing in relevant populations. K e y w o rd s : HIV test; Risk behaviour; Perceived risk; GUM clinic; Health promotion. Introduction Although the actual number of HIV tests has incre a s e d since its inception in 1985, re s e a rch has identified that a p p roximately 40% of individuals with risk factors for HIV infection have not been tested for the HIV antibody. 1 Furthermore, research in both the US and in Scotland has found that HIV positive individuals were tested late in their course of HIV infection. 2 , 3 The identification (and removal) of factors which prevent or delay persons with risk factors from seeking testing, and if positive from seek-ing early medical care, is an issue which must be addre s s e d in all high risk populations. 3,4 Evidence from previous studies suggests that both phys-ical availability and psychological access 5 appear to affect utilisation of testing services. Potential barriers to testing include: fear of a positive test re s u l t ; 6 fear of stigma and d i s c r i m i n a t i o n ; 5 and negative consequences in re l a t i o n-s h i p s . 7 In addition concerns over the confidentiality/ anonymity of the testing process 8,9,10 and increased anxiety at having to wait for test re s u l t s 1 1 , 1 2 , 1 3 p revent many of those at high risk from entering the testing process. F u rt h e rm o re, the association between perceived risk and seeking testing is unclear. Several studies 1 4 , 5 found perc e i v e d risk to be a leading reason for seeking testing, whereas a m o re recent paper did not re p o rt this finding. 3 The inter-action between risk behaviours, risk perceptions, and intentions to be tested, has been identified as a specific are a for future research. 4 T h e re are several criticisms of the work cited above. F i r s t l y, gay male populations have been utilised to re s e a rc h individual elements of either service provision or social/ psychological barriers to testing. There is a need to evalu-ate these elements in combination across a range of risk g roups. With the incidence of heterosexually transmitted HIV increasing over recent years both in Scotland 1 5 a n d w o r l d w i d e , 1 6 , 1 7 this is one risk group that re q u i res furt h e r re s e a rch. Secondly, the studies reviewed are pre d o m i n a n t l y American, and therefore the generalisation of their results is unknown. Finally, re s e a rch of the HIV testing pro c e s s has been mainly atheoretical. 18 The model of health care utilisation 1 9 has been used in prior studies to conceptualise the factors that predict both intentions to be tested and actual HIV testing. 4 , 2 0 T h i s model hypothesises that predisposing characteristics (eg. demographics), enabling characteristics (eg. family re s o u rces), and need characteristics (eg. perceived and actual risk of disease) influence utilisation. The present study intends to compare three groups of subjects categorised by their HIV testing status (alre a d y tested, planning to be tested and not testing) in order to : q evaluate factors that predict HIV testing using the model of health care utilisation 20 as its conceptual framework. q analyse some of the factors that encourage or inhibit seeking an HIV test in this population.