HIV prevention programs are tailored to selected groups based on an understanding of the distribution of risky behaviors in the population and the association between these risky behaviors and infection. For example, data on sexual behaviors and drug use have allowed the CDC to guide the planning, implementation, and evaluation of HIV prevention services to men who have sex with men (MSM) and injection drug users (IDU). HIV testing remains an important component of prevention activities; learning one's HIV status is the key stepping stone into care or ongoing behavioral risk reduction services (Janssen et al, 2001; CDC, 2003).

This report focuses on HIV testing patterns and risk behaviors among three groups at high risk for HIV infection: men who have sex with men recruited from gay bars, injection drug users recruited through street outreach or at needle exchange programs (NEP), and high risk heterosexuals (HRH) recruited at sexually transmitted disease (STD) clinics. Data in this report comes from the HIV Testing Survey (HITS) which was conducted in the states of California, Louisiana and Vermont and the cities of San Francisco, CA and Philadelphia, PA in 2001. See the Technical Notes at the end of this report for more information on HITS methods.

For MSM and IDU, at least 80% of HITS participants had ever been tested for HIV; most had been tested more than once and about 65% had been tested in the year before the interview (Tables 3, 4). By comparison, a lower percentage of heterosexuals had been tested ever (72%) and in the past year (50%; Tables 3, 4). All MSM from site E reported having ever been HIV tested (Table 3). These participants were recruited from bars in neighborhoods with HIV testing facilities nearby and HIV outreach activities in the bars were common. 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), while among those not tested, common reasons for not testing included thinking it was unlikely they had been exposed to HIV, being afraid of testing positive and thinking they were HIV-negative (Table 6). These reasons are similar to reasons reported by participants in previous waves of HITS (Kellerman et al, 2002; Hecht et al, 2000; CDC, 2000). Of those tested in the past 12 months, about 50% of MSM and IDU were tested anonymously, compared to 32% of HRH (Table 8).

Although some have held concerns that HIV case surveillance policies may have a potentially deterrent effect on testing behaviors, previous HITS data has shown this is not a widespread problem (Hecht, 2000; Lansky, 2002). In HITS-2001, overall less than 10% of participants could correctly identify their state's HIV case surveillance policy, half chose an incorrect response and about 40% did not know at all (Table 9). A large proportion (27%) of MSM recruited in site G were able to correctly identify the state’s HIV case surveillance policy (Table 9). This state’s reporting policy was changed recently and was widely publicized by the media as well as community organizations. A large proportion (18%) of site B’s HRH were also able to correctly identify the state’s HIV case surveillance policy. In two of the three STD clinics where the survey was performed, clinic attendees are asked to give informed consent for an HIV test when they register for services. This consent process includes informing clients of the state’s reporting policy.

Drug use and sexual behavior data indicate a high risk population was reached through HITS. Among 599 IDU, 42% had shared needles in the 12 months before the interview (Table 10) and 54% had shared other injecting equipment (Table 11). Of those who reported sharing needles, 18% said they "always" used bleach to clean their needles. Among 594 MSM and 505 HRH, 75% of MSM, 75% of heterosexual men and 57% of heterosexual women had more than one sex partner in the past 12 months (Fig. 4). In all three of these groups, a lower proportion "always" used condoms with their primary partners than with their other partners; however, a higher proportion engaged in riskier sexual behaviors (receptive anal sex for MSM, anal sex for heterosexuals) with their primary than their non-primary partners (Tables 13, 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 targeting high risk individuals 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 (Janssen et al, 2001; CDC, 2002; CDC, 2003). Information generated from HITS should be used to help direct both ongoing and new prevention programs for high-risk populations at the state, local, and national level.

References

Centers for Disease Control and Prevention. Advancing HIV Prevention: New Strategies for a Changing Epidemic – United States, 2003. MMWR. 2003;52(15):329-332.

Centers for Disease Control and Prevention. HIV/AIDS Special Surveillance Report; HIV Testing Survey, 2000 Vol.1 No.1.

Centers for Disease Control and Prevention. HIV prevention strategic plan through 2005.

Hecht FM, Chesney M, Lehman JS, et al. Does HIV Reporting by Name Deter Testing? AIDS. 2000;14:1801-1808.

Janssen RS, Holtgrave DR, Valdiserri RO, et al. The Serostatus Approach to Fighting the HIV Epidemic: prevention strategies for infected individuals. Am J Public Health. 2001;91:1019-1024.

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 Immunodeficiency Syndromes and Human Retrovirology 2002;31:202-210.

Lansky A, Lehman JS, Gatwood J, Hecht R, Fleming PL. Change in HIV testing patterns after implementation of name-based HIV surveillance reporting in New Mexico. American Journal of Public Health 2002;92:1757.