Printer Friendly

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.
COPYRIGHT 2003 U.S. Government Printing Office
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2003 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Publication:Morbidity and Mortality Weekly Report
Geographic Code:1USA
Date:Jun 13, 2003
Words:3479
Previous Article:Multistate outbreak of monkeypox -- Illinois, Indiana, and Wisconsin, 2003.
Next Article:Varicella-related deaths -- United States, 2002.
Topics:

Terms of use | Privacy policy | Copyright © 2022 Farlex, Inc. | Feedback | For webmasters |