Disparities in HIV testing based on testing location

Abstract

Purpose: Studies are increasingly explicating the role of service location in access to care, including distance to nearest service provider (Stahler et al 2009) and, specifically with regard to HIV testing, zip code (Allgood et al 2009). Because 25% of those infected with HIV are unaware of their positive status (CDC 2009), immediate access to testing is vital. Although HIV testing providers attempt to reach all, some community members are left without access. We hypothesized that rates of HIV testing would vary by zip code in St Louis, with those living in zip codes with testing services more likely to have been tested than those living in zip codes without testing services. Methods: Data on the demographics and health factors of 914 individuals recruited using community outreach methods through HealthStreet (Center for Community Based Research, Community Recruitment and Retention Arm, Institute of Clinical and Translational Sciences [CTSA; Polonsky KS, PI], Washington University in St Louis) were analyzed. Home zip codes were dichotomized into test site present vs not. Results: Bivariate testing was used to examine whether reporting having been tested for HIV was predicted by home zip code, HIV-positive status, ever having 1 of 5 sexually transmitted infections, and ever using a variety of illicit drugs, including heroin. Of the 914 individuals screened, 77 (8.4%) reported ever having been tested for HIV; of those, 67 lived in a zip code with a test site (χ = 34.31, P b .0001). A history of chlamydia and gonorrhea and lifetime drug use increased the likelihood of testing. Living in a zip code with an HIV testing site increased the likelihood of ever being tested for HIV 6.1 times (95% CI 3.10-13.03) that of not living in such an access area. In a regression model, only lifetime illegal drug use also increased the likelihood of HIV testing. City and State Health Department data were examined for additional factors. Zip codes with an HIV testing provider have lower mortality, do not have the highest rate of AIDS cases, and are in the lower or middle of the range for risk factors, providing no alternative explanation for this finding (Health Department 2001). Conclusion: In St Louis, those who live close to testing services have better access to HIV testing services than those who live in zip codes further from testing sites regardless of risk status. Mobile HIV testing would help ensure better access.