November 01, 2011
3 min read

Despite stable HIV testing rates among US men, more work needed

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BOSTON — Overall rates for HIV testing among men with high risk heterosexual contact and sexually active men who have sex with men remained stable in the United States during two different cycles — 2002 and between 2006 and 2008. However, Candice K. Kwan, MD, said more work is needed to increase HIV testing in this population.

“Less than 50% of men at high risk of HIV infection reported HIV testing within the prior year, and we were unable to detect any statistical differences in the rates for HIV testing within the prior year from 2002 to 2006 and 2008 among these men, although it may have been too early to detect changes in uptake of the 2006 HIV testing guidelines,” Kwan, of the CDC, said during a presentation at the 49th Annual Meeting of the Infectious Diseases Society of America.

Data were pooled from the 2002 and the 2006 and 2008 cycles of the National Survey of Family Growth that included Americans aged 15 to 44 years.

The primary objective was to assess the proportion of men who reported HIV testing within the prior year among men with high risk heterosexual contact and in sexually active MSM. Secondary objectives were to assess for correlates in HIV testing and changes in the proportion of men who reported HIV testing before and after the revisions of the 2006 CDC HIV testing guidelines.

Participants were stratified by sexual behavior. Heterosexual men at high risk were defined as those who did not report having sex with men within the prior year and had one of the following risk behaviors: having sex with multiple female partners; having sex with a female for drugs or money; or having sex with a female partner who is non-monogamous who injected drugs or was HIV-infected. Sexually active MSM were defined as having sex with at least one male partner within the prior year.

Heterosexual men

Among heterosexual men at high risk, researchers observed an independent association between those aged younger than 18 years and a decreased likelihood for having been tested for HIV within the prior year.

In the univariate analysis, Kwan and colleagues found that blacks were more likely to be associated with being tested for HIV, whereas in multivariate analysis, no association was observed for race or ethnicity after adjusting for age, receipt of physical exam, treatment or testing for an STD or having health insurance.

Compared with 35% of men who received a physical exam within the prior year, 13% of men who did not receive a physical exam within the prior year reported receiving HIV testing. Moreover, 64% of men who received STD testing or treatment received HIV testing vs. only 8% of men who did not receive testing or treatment for STDs.

Sexually active MSM

Unlike heterosexual males, age was not associated with receiving HIV testing within the previous year among sexually active MSM. No association was observed with race or ethnicity and receiving HIV testing.

Among sexually active MSM who did not receive a physical exam, according to Kwan, 47% reported receiving HIV testing vs. 31% of those who did receive a physical exam. Of those who received testing or treatment for STDs, 63% reported receiving HIV testing compared with 24% of those who received STD testing or treatment.

“Our analysis revealed low rates of HIV testing within the prior year among men at high risk for HIV infection, which suggests that, for these men, annual HIV testing is not being performed as frequently as recommended,” Kwan said. “There are opportunities to increase uptake of annual HIV testing among men at high risk for HIV infection, especially when they access health care services, such as physical exams and testing or treatment for STDs.” – by Jennifer Henry

For more information:

  • Kwan CK. #149. Presented at: IDSA 49th Annual Meeting; Boston; Oct. 20-23, 2011.

Disclosure: The researchers report no relevant financial disclosures.


This is an important study because it provides clear evidence that, even in the highest risk groups in the United States, testing for HIV infection still isn't done as frequently as necessary. While the finding that the frequency of testing was higher in those that received a physical exam or treatment for an STD indicated that HIV testing is being offered to those in care, the data show that much improvement is needed. In addition, the results overall show that HIV testing must be made more available and the obstacles to testing must be reduced, as many men at high risk are not in regular contact with medical care systems. Offering testing at sites where risk behaviors are common is one way to increase the frequency of testing among those at high risk.

- Joel Ernst, MD
Infectious Disease News Editorial Board member

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