Abstract
BackgroundOwing to the continuous increase in the number of new human immunodeficiency virus (HIV) infection in Korea, public health centers (PHCs) have performed anonymous tests since 1989. No study has examined the patterns of anonymous HIV testing performed at PHCs and the characteristics of HIV infection detected in those tests. We aimed to assess the influence of anonymous HIV testing on Korea’s national HIV surveillance.MethodsHIV screening test data from 253 PHCs over a 16-year period were classified into 13 groups based on reason for testing. For anonymous HIV test takers (Anonymous), the HIV positivity per 10,000 tests was calculated, as repetitions could not be distinguished. Those with suspected HIV infection voluntarily underwent HIV testing and revealed their identity (Suspected). HIV prevalence was calculated as the number of HIV-positive persons per 10,000 test takers. Analyses were performed using chi-square and Cochran-Armitage trend test with SAS 9.4.ResultsApproximately 400,000 HIV screening tests were performed at PHCs annually, which remained unchanged in the past 10 years. The proportion of anonymous testing increased from < 3.0% before 2014 to 4.8% in 2014 and 6.1% in 2015. While the number of HIV cases increased, the number of anonymous HIV-positive test results per 10,000 tests decreased from 68.8 in 2010 to 41.8 in 2015. The HIV prevalence among the suspected was approximately 20.0 per 10,000 test takers before 2014, which steeply increased to 71.6 in 2015. Those with suspected HIV were predominantly men, aged 20 years, foreigners, and metropolitan city dwellers in the last 6 years. The high prevalence of persons with suspected HIV resulted in a doubling of HIV prevalence at PHCs between 2014 and 2015.ConclusionsAnonymous and Suspected, which were driven by similar motives, impacted each other. Increase in HIV prevalence among the suspected led to a higher HIV prevalence among all test takers in PHCs and higher proportions of HIV infection nationwide, which could be attributed to the increase in the number of anonymous tests performed in PHCs. HIV positivity among the anonymous and HIV prevalence among the suspected are key indexes of the national HIV surveillance in Korea.
Highlights
Owing to the continuous increase in the number of new human immunodeficiency virus (HIV) infection in Korea, public health centers (PHCs) have performed anonymous tests since 1989
940,000 people died of acquired immune deficiency syndrome (AIDS) in 2017, indicating that the public health burden associated with HIV infection is extremely high [1]
In a previous study on trends in HIV prevalence among overall visitors to PHCs from 2000 to 2009, we reported that the proportion of new cases of HIV infection detected at PHCs each year had increased to 18% of total new HIV infection cases [9]
Summary
Owing to the continuous increase in the number of new human immunodeficiency virus (HIV) infection in Korea, public health centers (PHCs) have performed anonymous tests since 1989. While new cases of human immunodeficiency virus (HIV) infection are declining globally, 36.7 million people were diagnosed with HIV, and around 1.8 million new cases are reported annually. In Korea, since the first case of HIV infection was diagnosed in 1985, approximately 14,000 people have been diagnosed with HIV infections between 1985 and 2015, and the number of persons newly diagnosed with HIV infection continues to increase annually. HIV infection is predominantly detected through HIV tests performed in hospitals, public health centers (PHCs), and blood banks [4]. 10 million HIV screening tests are performed annually in Korea [6, 7]. A total of 253 PHCs in Korea conduct approximately 400,000 HIV screening tests annually, accounting for 3–4% of the total proportion of HIV screening tests in Korea [8]
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