HIV testing -- United States, 2001.
As of December 2001, a cumulative total of 816,149 cases of acquired immunodeficiency syndrome (AIDS) had been reported to CDC (1). One of CDC's national human immunodeficiency virus (HIV)--prevention goals for 2005 (Goal 2) is to increase the proportion of HIV-infected persons in the United States who know they are infected from an estimated 70% to 95% (2). A goal of the new CDC initiative, Advancing HIV Prevention: New Strategies for a Changing Epidemic, is to ensure that every HIV-infected person has the opportunity to be tested and has access to state-of-the-art medical care and prevention services needed to prevent HIV transmission (3). To characterize the prevalence of HIV-antibody testing among U.S. adults, CDC analyzed data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS). The findings document variability in HIV testing prevalence by area and by sex within areas, underscoring the ongoing need to promote voluntary HIV counseling and testing that will provide persons with early knowledg e of their HIV status and offer them access to appropriate counseling and treatment.BRFSS is a state-based, random-digit-dialed telephone survey of the civilian, noninstitutionalized population aged 18 years in the 50 states, the District of Columbia (DC), Guam, Puerto Rico, and the U.S. Virgin Islands. In 2001, a total of 170,412 persons aged 18-64 years responded to questions about HIV-and AIDS-related knowledge, attitudes, and HIV-antibody testing history. Sample sizes ranged from 802 in Guam to 7,019 in Massachusetts. All estimates were weighted by demographic characteristics and selection probabilities; confidence intervals were calculated by using SUDAAN to account for the complex survey design.
Survey participants were asked, "As far as you know, have you ever had your blood tested for HIV?" Participants were directed nor to count tests they might have had as part of a blood donation (4). The percentage of respondents who reported being tested ranged from 3 1.5% (South Dakota) to 65.3% (DC) (median: 45.6%) (Table 1). The month and year of the most recent test were used to identify persons whose most recent test was during the 12 months preceding the interview. Respondents who reported being tested in 2001 but who did not report the month were included in the group tested recently. Approximately 2% of respondents reported being tested in 2000 but could not remember the month in which they were tested and were coded as not having been tested recently. Of those ever tested, a median of 27.7% (range: 18.5% [Maine]--39.6% [Virgin Islands]) were tested during the 12 months preceding the interview (Table 1). The median age of persons who reported ever having been tested for HIV was 35.1 years (range: 32.2 [North Dakota]-37.2 [DC] years). Approximately 59.6% of respondents aged 20-39 years had ever been tested (range: 42.7% [South Dakota]--72.0% [Alaska]). Testing rates declined after age 40 years to 22.1% of respondents aged 60-64 years (range: 8.6% [Kansas]- 39.6% [Nevada]).
Respondents who reported ever having been tested were asked, "What was the main reason you had your test for HIV?" Participants who reported that they were tested primarily to learn their infection status (i.e., those whose responses included "just to find out if infected," "routine check-up," "doctor referral," "sex partner referral," "because of pregnancy, "because I am at risk," or "other") were coded as being tested voluntarily (5). Persons who reported that they were tested because of illness, hospitalization, surgical procedure, insurance, employment, marriage license, military service, immigration, or occupational exposure were coded as not being tested voluntarily. Among those ever tested, the percentage of persons who reported that their most recent HIV test was voluntary ranged from 53.0% (South Dakota) to 80.2% (DC) (median: 63.8%) (Table 2).
Among those ever tested, few statistically significant differences between men and women were found except for the reason they were tested. Women were more likely than men ever to have been tested in nine states (California, Kentucky, Louisiana, Minnesota, Mississippi, Montana, Tennessee, Texas, and Washington) and in Puerto Rico. A median of 44.4% of men (range: 30.8% [South Dakota]-59.3% [Nevada]) and of 47.5% of women (range: 31.7% [North Dakota]-59.9% [Nevada]) reported ever having been tested for HIM Among those persons ever tested, a median of 29.1% of men and 27.0% of women had their most recent test during the 12 months preceding the interview (range: 21.0% [Maine]-41.5% [Virgin Islands] for men; 16.3% [Maine]-38.1% [Virgin Islands] for women). Of those tested, the difference in recent HIV testing between men and women was statistically significant only in Hawaii (men, 36.1%; women, 21.5%).
In 47 states, Guam, Puerto Rico, and the U.S. Virgin Islands, a significantly higher proportion of women than men reported being tested voluntarily (Table 2). Among those ever tested, a median of 72.2% of women reported that their most recent HIV test was voluntary (range: 61.4% [South Dakota]-81.9% [DC]), compared with a median of 54.8% of men (range: 42.4% [Delaware]-78.3% [DC]).
HIV testing prevalence was >50% in eight states (Alaska, California, Florida, Georgia, Maryland, Nevada, South Carolina, and Virginia), DC, and the U.S. Virgin Islands and <40% in eight states (Iowa, Kentucky; Minnesota, Nebraska, North Dakota, South Dakota, Utah, and West Virginia) (Figure). In states where the AIDS rate * was high (1), HIV testing also tended to be high. For example, in 2001, Florida ranked third in both AIDS rate (31.3) (1) and testing (57.2%). However, in Alaska, where AIDS incidence was low (2.8), the prevalence estimate for testing was among the highest (56.9%).
Reported by: KA Mack, PhD, Div of Adult and Community Health, A Lansky, PhD, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
Editorial Note: This report indicates that approximately half (median: 45.6%) of persons in the United States aged 18-64 years have been tested for HIM This finding is consistent with previous BRFSS data indicating increased testing rates (6) and with other general population surveys (4). The proportion of persons tested for HIV varied by area and sex. The variability in HIV testing by area probably represents area-specific differences in the prevalence of HIV infection and AIDS and in the scope of HIV-prevention and -education programs. The variability in HIV testing by sex probably is attributable to pregnancy testing; 28.5% of women reported that the reason for their most recent test was pregnancy. Because an increasing proportion of persons with AIDS are women (7), variability in HIV testing by sex should be monitored. Differences between men and women in testing prevalence and reasons for being tested might have implications for developing HIV-prevention and -education programs.
The findings in this report are subject to at least three limitations. First, BRESS excludes persons without telephones and those who ate institutionalized. Second, BRFSS data are self-reported and thus are subject to recall bias in testing reports. Finally, the median response rate was 51.1% (range: 33.3% [New Jersey]-81.5% [Puerto Rico]); however, BRESS data have minimal bias (8).
Although general population surveys such as BRFSS reach a population that is generally at low risk for HIV infection (9), such surveys provide useful data about the HIV-antibody testing behaviors of U.S. adults outside of public clinics. BRFSS data can be used to assess progress toward achieving the goals of CDC's HIV-prevention strategic plan (2). The findings indicate an ongoing need to promote voluntary HIV counseling and testing and underscore the importance of reducing barriers for early diagnosis of HIV infection and providing persons with knowledge of their HIV status and access to counseling and treatment to prevent further transmission (3).
TABLE 1
Percentage of persons aged 18-64 years who reported ever having had an
HIV test and percentage of those tested who reported having had their
most recent HIV test during the preceding 12 months, by area --
Behavioral Risk Factor Surveillance System, United States, 2001
Ever tested
Sample
Area size % (95% CI *)
Alabama 2,227 47.4 (44.9-49.8)
Alaska 2,605 56.9 (53.9-60.0)
Arizona 2,504 47.4 (44.5-50.3)
Arkansas 2,310 43.2 (40.8-45.5)
California 3,493 50.0 (47.8-52.1)
Colorado 1,729 49.2 (46.4-51.9)
Connecticut 6,170 48.0 (46.4-49.5)
Delaware 2,746 49.6 (47.1-52.0)
District of Columbia 1,568 65.3 (62.3-68.4)
Florida 3,474 57.2 (55.2-59.2)
Georgia 3,805 54.7 (52.6-56.8)
Guam 802 42.5 (38.5-46.5)
Hawaii 3,638 41.4 (39.2-43.6)
Idaho 3,838 41.2 (39.2-43.2)
Illinois 3,254 46.1 (43.3-48.8)
Indiana 3,218 42.2 (40.2-44.1)
Iowa 2,711 33.4 (31.2-35.5)
Kansas 3,683 41.1 (39.2-42.9)
Kentucky 5,892 39.6 (37.7-41.5)
Louisiana 4,079 47.4 (45.6-49.2)
Maine 1,918 42.4 (39.8-45.0)
Maryland 3,645 55.8 (53.7-57.9)
Massachusetts 7,019 46.4 (44.9-47.8)
Michigan 3,111 46.9 (44.8-48.9)
Minnesota 3,172 37.4 (35.5-39.4)
Mississippi 2,429 47.9 (45.5-50.3)
Missouri 3,247 43.3 (41.0-45.7)
Montana 2,596 43.5 (40.8-46.2)
Nebraska 2,803 32.5 (30.5-34.6)
Nevada 2,118 59.6 (56.5-62.7)
New Hampshire 3,334 44.8 (42.8-46.8)
New Jersey 4,814 47.7 (45.7-49.6)
New Mexico 2,875 47.6 (45.4-49.8)
New York 3,229 49.9 (47.8-51.9)
North Carolina 4,951 49.5 (47.3-51.6)
North Dakota 2,015 34.0 (31.7-36.3)
Ohio 2,732 41.3 (39.0-43.6)
Oklahoma 3,482 40.6 (38.4-42.8)
Oregon 2,046 45.2 (42.8-47.7)
Pennsylvania 2,842 40.0 (37.8-42.1)
Puerto Rico 3,292 44.4 (42.1-46.8)
Rhode Island 3,251 48.1 (46.0-50.3)
South Carolina 2,618 51.0 (48.7-53.4)
South Dakota 3,808 31.5 (29.8-33.2)
Tennessee 2,393 43.2 (40.8-45.7)
Texas 4,881 49.5 (47.8-51.1)
Utah 3,077 33.7 (31.6-35.9)
Vermont 3,566 43.3 (41.4-45.2)
Virgin Islands 1,937 58.1 (55.2-60.9)
Virginia 2,418 54.0 (51.6-56.5)
Washington 3,462 49.1 (47.2-51.1)
West Virginia 2,333 39.7 (37.4-42.0)
Wisconsin 2,760 40.8 (38.6-43.0)
Wyoming 2,492 41.9 (39.7-44.1)
Total (median) 170,412 45.6
Tested during preceding 12 months
Area % (95% CI)
Alabama 35.8 (32.4-39.3)
Alaska 32.5 (28.6-36.4)
Arizona 26.8 (23.3-30.4)
Arkansas 29.3 (26.1-32.6)
California 27.0 (24.4-29.5)
Colorado 28.3 (24.9-31.7)
Connecticut 27.4 (25.4-29.5)
Delaware 33.1 (29.9-36.4)
District of Columbia 37.0 (33.4-40.5)
Florida 32.4 (29.8-35.0)
Georgia 32.7 (30.0-35.3)
Guam 29.2 (23.9-34.5)
Hawaii 29.0 (25.7-32.2)
Idaho 26.6 (23.9-29.4)
Illinois 25.7 (22.1-29.3)
Indiana 28.6 (25.8-31.5)
Iowa 25.2 (21.8-28.6)
Kansas 26.3 (23.8-28.9)
Kentucky 27.4 (24.5-30.2)
Louisiana 35.5 (33.0-38.1)
Maine 18.5 (15.0-22.0)
Maryland 31.5 (28.9-34.1)
Massachusetts 25.1 (23.2-26.9)
Michigan 27.1 (24.3-29.9)
Minnesota 28.3 (25.1-31.4)
Mississippi 33.5 (30.0-36.9)
Missouri 31.5 (28.2-34.8)
Montana 25.8 (22.2-29.4)
Nebraska 26.7 (23.3-30.1)
Nevada 34.4 (30.0-38.9)
New Hampshire 22.9 (20.3-25.5)
New Jersey 27.2 (24.8-29.7)
New Mexico 33.0 (30.0-36.1)
New York 30.1 (27.4-32.8)
North Carolina 30.6 (27.8-33.4)
North Dakota 27.2 (23.4-31.0)
Ohio 25.8 (22.7-28.9)
Oklahoma 25.5 (22.2-28.7)
Oregon 24.6 (21.6-27.6)
Pennsylvania 26.9 (23.7-30.1)
Puerto Rico 27.4 (24.1-30.8)
Rhode Island 29.8 (26.9-32.8)
South Carolina 33.9 (30.6-37.1)
South Dakota 27.2 (24.2-30.1)
Tennessee 26.0 (22.7-29.3)
Texas 34.3 (32.1-36.5)
Utah 28.2 (24.7-31.7)
Vermont 24.2 (21.6-26.9)
Virgin Islands 39.6 (35.9-43.4)
Virginia 31.8 (28.7-34.9)
Washington 24.1 (21.8-26.4)
West Virginia 28.0 (24.6-31.4)
Wisconsin 27.3 (24.2-30.3)
Wyoming 24.7 (21.7-27.8)
Total (median) 27.7
Confidence interval.
TABLE 2
Percentage of persons aged 18-64 years among those ever tested for HIV
who reported that their last test was voluntary, by area and sex --
Behavioral Risk Factor Surveillance System, United States, 2001
Men Women
Area % (95% CI +) % (95% CI)
Alabama 52.8 (46.9-58.7) 75.3 (71.7-78.8)
Alaska 55.0 (48.9-61.2) 74.8 (70.5-79.0)
Arizona 64.1 (58.3-69.9) 73.6 (69.1-78.1)
Arkansas 56.9 (51.3-62.5) 72.4 (68.3-76.4)
California 62.3 (57.9-66.7) 74.7 (71.2-78.1)
Colorado 55.4 (49.8-61.1) 73.8 (69.4-78.3)
Connecticut 52.8 (49.3-56.3) 68.7 (66.0-71.3)
Delaware 42.4 (37.1-47.8) 62.2 (58.0-66.4)
District of Columbia 78.3 (73.6-83.1) 81.9 (78.4-85.4)
Florida 64.3 (60.3-68.4) 71.4 (68.4-74.3)
Georgia 52.5 (47.9-57.0) 71.8 (68.7-74.9)
Guam 48.7 (40.1-57.3) 71.4 (64.4-78.4)
Hawaii 47.7 (42.4-53.1) 69.4 (65.2-73.6)
Idaho 53.3 (48.5-58.1) 72.9 (69.4-76.4)
Illinois 49.6 (43.2-56.0) 69.4 (64.5-74.3)
Indiana 54.0 (49.2-58.7) 75.6 (72.3-78.9)
Iowa 49.9 (44.0-55.9) 71.5 (66.8-76.1)
Kansas 55.4 (50.9-59.8) 71.8 (68.5-75.0)
Kentucky 53.6 (48.8-58.4) 72.2 (68.8-75.7)
Louisiana 61.3 (57.1-65.4) 71.0 (68.1-73.9)
Maine 53.1 (46.9-59.3) 67.1 (62.4-71.8)
Maryland 61.3 (57.0-65.7) 74.4 (71.3-77.5)
Massachusetts 56.0 (52.9-59.1) 66.6 (64.0-69.1)
Michigan 50.7 (46.0-55.5) 68.2 (64.8-71.6)
Minnesota 55.8 (50.6-61.0) 72.8 (69.0-76.5)
Mississippi 48.9 (43.0-54.8) 75.0 (71.4-78.6)
Missouri 60.5 (55.1-66.0) 74.3 (70.5-78.1)
Montana 49.1 (42.6-55.6) 66.9 (61.8-72.0)
Nebraska 47.6 (41.6-53.6) 66.2 (61.7-70.7)
Nevada 54.4 (47.8-61.1) 66.1 (60.7-71.5)
New Hampshire 54.6 (50.2-59.0) 69.0 (65.5-72.5)
New Jersey 60.3 (56.3-64.4) 72.8 (69.8-75.8)
New Mexico 59.7 (54.9-64.5) 75.1 (71.6-78.7)
New York 59.0 (54.6-63.4) 71.3 (67.9-74.8)
North Carolina 59.7 (55.2-64.2) 74.9 (71.1-78.7)
North Dakota 46.8 (40.8-52.8) 72.5 (67.4-77.7)
Ohio 55.6 (49.7-61.4) 70.6 (66.7-74.5)
Oklahoma 50.2 (44.9-55.5) 72.8 (68.9-76.8)
Oregon 60.2 (55.0-65.3) 72.3 (68.0-76.5)
Pennsylvania 55.4 (50.0-60.7) 72.3 (68.5-76.0)
Puerto Rico 56.2 (50.3-62.1) 74.4 (70.8-78.0)
Rhode Island 55.3 (50.4-60.1) 70.1 (66.9-73.4)
South Carolina 54.8 (49.7-59.9) 73.7 (70.1-77.2)
South Dakota 44.3 (39.4-49.2) 61.4 (57.1-65.6)
Tennessee 53.9 (47.4-60.4) 70.3 (66.5-74.1)
Texas 55.6 (52.0-59.2) 75.3 (72.7-77.9)
Utah 47.0 (41.3-52.8) 68.9 (64.0-73.7)
Vermont 52.6 (48.0-57.2) 67.6 (64.1-71.1)
Virgin Islands 54.9 (50.2-59.5) 72.0 (68.3-75.6)
Virginia 65.6 (59.9-71.2) 80.4 (76.7-84.2)
Washington 55.9 (51.7-60.0) 75.1 (72.2-78.0)
West Virginia 49.0 (43.2-54.7) 68.2 (63.9-72.4)
Wisconsin 58.4 (53.3-63.4) 72.6 (68.5-76.7)
Wyoming 49.8 (44.4-55.2) 73.0 (69.2-76.8)
Total (median) 54.8 72.2
Total
Area % (95% CI)
Alabama 64.9 (61.5-68.3)
Alaska 64.7 (60.9-68.5)
Arizona 68.8 (65.2-72.5)
Arkansas 65.0 (61.6-68.5)
California 68.8 (66.0-71.5)
Colorado 64.7 (61.0-68.3)
Connecticut 61.1 (58.9-63.3)
Delaware 53.1 (49.7-56.5)
District of Columbia 80.2 (77.4-83.1)
Florida 68.1 (65.6-70.5)
Georgia 62.3 (59.5-65.1)
Guam 58.8 (52.8-64.7)
Hawaii 58.3 (54.9-61.8)
Idaho 63.5 (60.5-66.5)
Illinois 60.1 (56.1-64.1)
Indiana 65.2 (62.3-68.1)
Iowa 61.5 (57.6-65.3)
Kansas 63.8 (61.0-66.5)
Kentucky 64.0 (61.1-66.9)
Louisiana 66.6 (64.2-69.1)
Maine 60.5 (56.6-64.3)
Maryland 68.3 (65.7-70.9)
Massachusetts 61.5 (59.5-63.5)
Michigan 60.0 (57.0-62.9)
Minnesota 64.9 (61.7-68.1)
Mississippi 63.4 (60.0-66.9)
Missouri 67.9 (64.6-71.1)
Montana 58.8 (54.7-62.9)
Nebraska 57.4 (53.6-61.3)
Nevada 60.2 (55.8-64.6)
New Hampshire 61.8 (58.9-64.7)
New Jersey 66.9 (64.4-69.4)
New Mexico 67.8 (64.9-70.8)
New York 65.5 (62.8-68.3)
North Carolina 67.7 (64.7-70.6)
North Dakota 58.6 (54.5-62.7)
Ohio 63.8 (60.3-67.2)
Oklahoma 61.9 (58.6-65.3)
Oregon 66.2 (62.8-69.6)
Pennsylvania 64.3 (61.1-67.6)
Puerto Rico 66.5 (63.2-69.9)
Rhode Island 62.9 (59.9-65.8)
South Carolina 64.4 (61.3-67.6)
South Dakota 53.0 (49.7-56.2)
Tennessee 63.2 (59.5-66.8)
Texas 66.3 (64.1-68.5)
Utah 58.3 (54.5-62.1)
Vermont 60.4 (57.4-63.3)
Virgin Islands 63.6 (60.6-66.6)
Virginia 73.8 (70.5-77.2)
Washington 66.0 (63.4-68.6)
West Virginia 59.1 (55.4-62.7)
Wisconsin 65.9 (62.6-69.2)
Wyoming 62.0 (58.6-65.3)
Total (median) 63.8
* Reasons given for testing include "just to find out if infected,"
"routine check-up." "doctor referral," "sex partner referral," "because
of pregnancy," "because I am at risk," or "other."
+ Confidence interval.
Acknowledgment
This report is based on data provided by BRFSS coordinators. Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.
* Per 100,000 population for July 2000--June 2001, reported through June 2001.
References
(1.) CDC. HIV/AIDS surveillance report, 2001. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC, 2001;13(2).
(2.) CDC. HIV prevention strategic plan through 2005. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC, 2001. Available at http://www.cde.gov/hiv/pubs/prev-strar-plan.pdf.
(3.) CDC. Advancing HIV prevention: new strategies for a changing epidemic--United Stares, 2003. MMWR 2003;52:329-32.
(4.) Holtzman D, Rubinson R, Bland S, McQueen D. HIV testing behavior and associated characteristics among U.S. adults, 1993 and 1994. AIDS and Behavior 1998;2:269-81.
(5.) Holtzman D, Mack K, Nakashima A, Rubinson R. Trends in HIV testing among U.S. adults, Behavioral Risk Factor Surveillance System (BRESS), 1994-2000. Poster presentation at the XIV International AIDS Conference, Barcelona, Spain, July 7-12, 2002.
(6.) Anderson JE, Carey JW, Taveras S. HIV testing among the general U.S. population and persons at increased risk: information from national surveys, 1987-1996. Am J Public Health 2000;90:1089-95.
(7.) Karon J, Fleming PL, Steketee RW, DeCock KM. HIV in the United States at the turn of the century: an epidemic in transition. Am J Public Health 2001;91:1060-8.
(8.) CDC. Public health surveillance for behavioral risk factors in a changing environment: recommendations from the Behavioral Risk Factor Surveillance Team. MMWR 2003;52(No. RR-9).
(9.) Holtzman D, Bland S, Lansky A, Mack K. HIV-related behaviors and perceptions among adults in 25 states: 1997 BRFSS. Am J Public Health 2001;91:1882-8.
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| Publication: | Morbidity and Mortality Weekly Report |
|---|---|
| Geographic Code: | 1USA |
| Date: | Jun 13, 2003 |
| Words: | 3479 |
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