Exploring Factors Associated with Recent HIV Testing among Heterosexuals at High Risk for HIV Infection Recruited with Venue-based Sampling.

Charles M Cleland,Marya Gwadz

doi:10.4172/2155-6113.1000544

Abstract

Annual HIV testing is recommended for high-risk populations in the United States, to identify HIV infections early and provide timely linkage to treatment. However, heterosexuals at high risk for HIV, due to their residence in urban areas of high poverty and elevated HIV prevalence, test for HIV less frequently than other risk groups, and late diagnosis of HIV is common. Yet the factors impeding HIV testing in this group, which is predominantly African American/Black and Latino/Hispanic, are poorly understood. The present study addresses this gap. Using a systematic community-based sampling method, venue-based sampling (VBS), we estimate rates of lifetime and recent (past year) HIV testing among high-risk heterosexuals (HRH), and explore a set of putative multi-level barriers to and facilitators of recent testing, by gender. Participants were 338 HRH African American/Black and Latino/Hispanic adults recruited using VBS, who completed a computerized structured assessment battery guided by the Theory of Triadic Influence, comprised of reliable/valid measures on socio-demographic characteristics, HIV testing history, and multi-level barriers to HIV testing. Logistic regression analysis was used to identify factors associated with HIV testing within the past year. Most HRH had tested at least once (94%), and more than half had tested within the past year (58%), but only 37% tested annually. In both men and women, the odds of recent testing were similar and associated with structural factors (better access to testing) and sexually transmitted infection (STI) testing and diagnosis. Thus VBS identified serious gaps in rates of annual HIV testing among HRH. Improvements in access to high-quality HIV testing and leveraging of STI testing are needed to increase the proportion of HRH testing annually for HIV. Such improvements could increase early detection of HIV, improve the long-term health of individuals, and reduce HIV transmission by increasing rates of viral suppression.

Highlights

Of the 1.2 million individuals living with HIV in the United States, 14% are unaware of their diagnoses [1]
The present study explores a set of putative barriers to and facilitators of past-year HIV testing among African American/Black and Hispanic/Latino high-risk heterosexuals (HRH)
It advances what is known about the frequency of testing, and factors that facilitate testing, in an under-studied population, HRH, using a rigorous community-based sampling method, venue-based sampling (VBS), in a highpoverty area

Summary

Introduction

Of the 1.2 million individuals living with HIV in the United States, 14% are unaware of their diagnoses [1]. A recent national study of high-risk populations indicated that fewer than half of vulnerable African Americans/Blacks and Hispanics/Latinos had been tested in the past year [8]. The present study explores a set of putative barriers to and facilitators of past-year HIV testing among African American/Black and Hispanic/Latino HRH. These factors are drawn from the empirical literature and conceptualized in the framework of the Theory of Triadic Influence [25], a social-cognitive theory delineating three “streams of influence” on health behavior: the individual/attitudinal-, social-, and structural-levels of influence. The present study’s aims, are to provide a description of our novel VBS sampling design, in which we used administrative data to define and enumerate potential recruitment locations to reach and engage HRH; to estimate rates of lifetime and recent (past year) testing among the sampled cohort of HRH; and explore multi-level barriers to/facilitators of recent testing, by gender

Methods

Design

Results

Discussion

Limitations