This report focuses on HIV testing patterns and risk behaviors among 3 groups at high risk for HIV infection: MSM recruited at gay bars, IDUs recruited through street outreach or at needle exchange programs (NEPs), and high-risk heterosexual adults (HRHs) recruited at sexually transmitted disease (STD) clinics. Data in this report come from the HIV Testing Survey (HITS), which was conducted in the states of Florida, Illinois, Michigan, New Jersey, and Washington and the cities of Los Angeles (California), New York City (New York), Philadelphia (Pennsylvania), Houston (Texas), and Milwaukee (Wisconsin) in 2002. See the Technical Notes for more information on HITS methods.

Of the MSM and IDUs who participated in HITS, 88% had been tested for HIV: most had been tested more than once, and about 75% had been tested during the 12 months before the interview (Tables 3 and 4). By comparison, a smaller proportion of HRHs had been tested (ever, 73%; during the past year, 56%) (Tables 3 and 4). Among those tested, common reasons for testing included wanting to know and possibly having been exposed to HIV through sexual behavior or drug use (Table 5). Among MSM, 9% reported their main reason for testing was that it was time for their regular HIV test. Among those never tested, common reasons for not testing included thinking it was unlikely they had been exposed to HIV, thinking they were HIV-negative, and being afraid of testing positive (Table 6). These reasons are similar to reasons reported by participants in previous waves of HITS [3, 4, 5, 6]. Of those tested during the 12 months before interview, about 50% of MSM and IDUs, compared with 22% of HRHs, were tested anonymously (Table 8).

Despite concerns that HIV case surveillance policies might have a deterrent effect on testing behaviors, HITS data have shown that this is not a widespread problem [4, 5, 6, 7, 8]. In the 2002 HITS, less than 10% of participants correctly identified their state's HIV case surveillance policy (Table 9).

Data on drug use and sexual behavior indicate that a high-risk population was reached through HITS. Of 711 IDUs, 31% had shared needles during the 12 months before the interview (Table 10), and 44% had shared other injection equipment (Table 11). Of those who reported sharing needles, 19% said they always used bleach to clean their needles. Of 1056 MSM and 1052 HRHs, 69% of MSM, 71% of heterosexual men, and 47% of heterosexual women had more than 1 sex partner during the 12 months before interview (Fig. 4). In all 3 groups, a lower proportion always used condoms with their primary partners, compared with the proportion who always used condoms with other partners. However, a higher proportion engaged in risky sexual behaviors (receptive anal sex for MSM, anal sex for heterosexuals) with their primary partner than with their other partners (Tables 13 and 17)

Behavioral surveys in high-risk populations, such as HITS, are used by state and local areas to enhance planning for HIV prevention activities. Future success in decreasing the number of new HIV infections will result from sustained prevention efforts focused on persons at high risk and increasing knowledge of HIV serostatus among those who are infected as a gateway to sustained behavioral risk-reduction interventions as well as to care and treatment [1,2,9]. Information generated from HITS should be used to help direct ongoing and new prevention programs for high risk populations at the state, local, and national levels.

References

• Janssen RS, Holtgrave DR, Valdiserri RO, et al. The serostatus approach to fighting the HIV epidemic: prevention strategies for infected individuals. American Journal of Public Health 2001;91:1019-1024.
• CDC. HIV Prevention Strategic Plan Through 2005. Atlanta, Ga.: CDC; 2001. Accessed October 5, 2004.
• Kellerman S, Lehman JS, Lansky A, et al. HIV testing within at-risk populations in the United States and the reasons for seeking or avoiding HIV testing. Journal of Acquired Immune Deficiency Syndromes 2002;31:202-210.
• Hecht FM, Chesney M, Lehman JS, et al. Does HIV reporting by name deter testing? AIDS 2000; 14:1801-1808.
• CDC. HIV/AIDS Special Surveillance Report: HIV Testing Survey, 2000. Vol. 1, No. 1 . Atlanta, Ga.: CDC; 2003:1-27.
• CDC. HIV Testing Survey, 2001. Atlanta, Ga.: CDC: 2004:1-27. HIV/AIDS Special Surveillance Report 1.
• Lansky A, Lehman JS, Gatwood J, Hecht R, Fleming PL. Change in HIV testing after implementation of name-based HIV case surveillance in New Mexico . American Journal of Public Health 2002;92:1757.
• Schwarcz S, Stockman J, Delgado V, Scheer S. Does name-based HIV reporting deter high-risk persons from HIV testing? Results from San Francisco. Journal of Acquired Immune Deficiency Syndromes 2004;35:93-96.
• CDC. Advancing HIV Prevention: new strategies for a changing epidemic—United States, 2003. MMWR 2003;52:329-332.