High-risk individuals less likely to follow through on HIV testing plans

October 22, 2007

One-fourth of individuals at high risk for contracting HIV report planning to be tested for the virus in the next year, but fewer appear to follow through on that intention than individuals who are at lower risk, according to a report in the October 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

About 1.1 million U.S. individuals are affected with the HIV virus, and 24 percent to 27 percent do not know they are infected, according to background information in the article. The HIV epidemic is increasingly affecting groups not perceived as being high-risk, including women, the poor and individuals living in rural areas. "Initiatives to increase the rates of HIV testing, particularly among groups not traditionally perceived as being at high risk, have been advanced as a primary strategy in the effort to combat the HIV epidemic," the authors write.

Jan Ostermann, Ph.D., M.S., of Duke University, Durham, N.C., and colleagues analyzed data from 146,868 adults age 18 to 64 who were interviewed between 2000 and 2005 as part of the National Health Interview Surveys. Participants were asked whether any of a list of HIV risk factors, such as receiving blood clotting factors for hemophilia or using injection drugs, applied to them. They also reported their HIV testing history and whether they planned on being tested in the next year, in addition to how often they drank alcohol, whether they had symptoms of depression and their sociodemographic information, such as age, education and marital status.

Overall, rates of HIV testing remained approximately the same between 2000 and 2005, with 37 percent of participants reporting being tested in their lifetimes and 10 percent within the past year. Females, minorities and individuals who reported greater risks for HIV were more likely to be tested. However, even among those reporting a medium or high risk for HIV, fewer than 25 percent were tested in the previous year.

In addition, "the difference between planned and actual testing was greater for those with greater HIV risk factors," the authors write. "Indeed, those with a lifetime HIV risk factor, with medium or high self-perceived HIV risk, and with heavier alcohol consumption were all less likely to actually get tested than to report an intention to get tested." For example, among those who reported a lifetime risk factor for HIV, 16 percent fewer individuals received a voluntary HIV test than reported planning to get tested, compared with a 5.6 percent deficit between planned and actual testing for those with no risk factors.

"These findings suggest that considerable potential exists to increase testing in higher-risk groups if individual and structural barriers can be identified and addressed," the authors conclude. "Alcohol and mental health treatment sites, for example, may represent a valuable opportunity to increase testing rates for higher-risk populations who exhibit a marked demand for testing. Although compelling arguments have motivated the current focus on general population testing, such efforts should not come at the expense of ensuring access to and utilization of testing by higher-risk groups."
(Arch Intern Med. 2007;167(19):2128-2135. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This work was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

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