HIV Testing Survey Research Articles

HIV infections and AIDS cases in Poland in 2021 year.

Despite a temporary decrease in the number of newly HIV infections in Poland in 2020, a return to the growing number of new infections was observed in 2021 in the surveillance. The aim of the study was to assess the epidemiological situation of newly HIV infections and AIDS cases and death among AIDS cases in Poland in 2021 in comparison to the changes in preceding years. Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases received from doctors and laboratories and the results of the annual survey of HIV testing conducted by laboratories throughout the country. A dataset on clients from Voluntary Testing and Counselling, coordinated by the National AIDS Center, which anonymously collects epidemiological and behaviour data on tested people was used. In 2021 there were 1 367 HIV cases newly diagnosed in Poland (diagnosis rate 3.58 per 100,000), including 236 among non-Polish citizens. The number of HIV infections increased by 43.3% compared to the previous year and was higher by 3.8% compared to the median in 2015-2019 years. Similarly, among VCT clients, number of HIV increased by 45%, from 309 in 2020 to 448 in 2021 year. The total number of AIDS cases reported to surveillance was 62 (incidence 0.16 per 100,000). The HIV infection was most often detected in the age group 30-39 year (35.8%) and among men (82.1%). Among cases with known transmission route, 68.7% concerned among MSM. The percentage of AIDS cases diagnosed at the same time with HIV increased by more than 30 percent points (from 63.5% to 95.1% of all AIDS cases). In 2021 the number of newly detected HIV infections increased compared to the previous year, probably due to a reduction in restrictions related to the COVID-19 pandemic and increased in HIV testing rate.

Using testing history to estimate HIV incidence in mothers living in resource-limited settings: Maximizing efficiency of a community health survey in Mozambique.

Obtaining rapid and accurate HIV incidence estimates is challenging because of the need for long-term follow-up for a large cohort. We estimated HIV incidence among women who recently delivered in southern Mozambique by leveraging data available in routine health cards. A cross-sectional household HIV-testing survey was conducted from October 2017 to April 2018 among mothers of children born in the previous four years in the Manhiça Health Demographic Surveillance System area. Randomly-selected mother-child pairs were invited to participate and asked to present documentation of their last HIV test result. HIV-testing was offered to mothers with no prior HIV-testing history, or with negative HIV results obtained over three months ago. HIV incidence was estimated as the number of mothers newly diagnosed with HIV per total person-years, among mothers with a prior documented HIV-negative test. Among 5000 mother-child pairs randomly selected, 3069 were interviewed, and 2221 reported a previous HIV-negative test. From this group, we included 1714 mothers who had taken a new HIV test during the survey. Most of mothers included (83.3%,1428/1714) had a previous documented HIV test result and date. Median time from last test to survey was 15.5 months (IQR:8.0-25.9). A total of 57 new HIV infections were detected over 2530.27 person-years of follow-up. The estimated HIV incidence was 2.25 (95% CI: 1.74-2.92) per 100 person-years. Estimating HIV incidence among women who recently delivered using a community HIV-focused survey coupled with previous HIV-testing history based on patients' clinical documents is an achievable strategy.

HIV infections and AIDS in Poland in 2020.

The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections and AIDS cases and death among AIDS cases in Poland in 2020 in comparison to the changes in preceding years. Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases received from doctors and laboratories and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. A dataset on clients from anonymous Voluntary Testing and Counselling (VCT) network was also used. The activities of the VCT are coordinated by the National AIDS Center, which anonymously collects epidemiological and behavior data on people who come for testing. In 2020 there were 934 HIV cases newly diagnosed in Poland (diagnosis rate 2.44 per 100,000), including 100 among non-Polish citizens. The number of newly detected HIV infections decreased by 39.9% compared to the previous year and was lower by 26.9% compared to the median in 2014-2018 years. Similarly, among VCT clients, number of HIV diagnoses decreased by 42%, from 536 in 2019 to 308 in 2020 year, what was connected with 44% decreased in number of HIV tests. The total number of AIDS cases was 50 (incidence 0.13 per 100,000). The HIV infection was most often detected in the age group between 30 and 39 (35.7%) and among men (83.5%). Among cases with known transmission route, 68.5% concerned among men who had sexual contact with men (MSM). The percentage of AIDS cases diagnosed at the same time with HIV diagnosis decreased by almost 14 percent points in comparison to 2019 (from 75.8% to 62% of all incident AIDS cases). In 2020, the number of newly detected HIV infections decreased compared to the previousyear, however, this is not only due to a decrease in the number of infections, but rather to a lack of continuity inthe diagnostic and reporting system during the COVID-19 pandemic, as indicated by a smaller number of testsand greater delays in data reporting. Due to the chronic course of HIV infection, a full assessment of the impactof the COVID-19 pandemic will be possible in the future.

HIV infections and AIDS in Poland in 2019.

The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections, and AIDS cases, and death among AIDS cases in Poland in 2019 in comparison to the changes in preceding years. Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases received from doctors and laboratories and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. A dataset on clients from anonymous Voluntary Testing and Counselling (VCT) network was also used. The activities of the VCT are coordinated by the National AIDS Center, which collects epidemiological and behaviour data on people who come for testing. In 2019 there were 1,551 HIV cases newly diagnosed in Poland (diagnosis rate was 4.04 per 100,000), including 144 among non-Polish citizens. The frequency of newly detected HIV infections increased by 28.2% compared to the previous year and was higher by 21.4% compared to the median in 2013-2017 years. The total number of AIDS cases was 95 (incidence was 0.25 per 100,000) and 15 people died from AIDS disease (0.04 per 100,000 ). The HIV infection was most often detected in the age group between 30 and 39 (36%) and among men (85,1%). Among cases with known transmission route, 73.6% concerned among men who had sexual contact with men (MSM). The percentage of AIDS cases diagnosed at the same time with HIV diagnosis increased by almost 8 percent points in comparison to 2018 (from 73% to 81.1% of all incident AIDS cases). In 2019, the frequency of newly detected HIV infections increased compared to the previous year. All actions should be taken to provide medical care to people with newly detected HIV infection, including foreigners residing in Poland. Also HIV testing action should be promoted among total population. Initiatives should be taken to raise awareness of the risk of HIV infection and to disseminate methods of prevention of infection, especially among key populations. It is also advisable to integrate different data sources, the combination of which will allow to improve their quality, as well as reliable monitoring of key epidemiological indicators.

Self-rated mental health among sexual health service clients during the first months of the COVID-19 pandemic, British Columbia, Canada

We investigated self-reported mental health during the first three months of the COVID-19 pandemic (March–May 2020), using a survey of HIV-testing and sexual health service clients from British Columbia, Canada (N = 1198). Over half (55%) reported their mental health as poor at the beginning of the COVID-19 pandemic, more than double that of the general Canadian population in the same time frame (22%). Acknowledging that this burden of poor mental health that is likely to persist in the coming years, we propose that sexual health clinics should facilitate access to mental health supports as a low-barrier point of primary care contact.

HIV and AIDS in Poland in 2018.

The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections and AIDS cases and death among AIDS cases in Poland in 2018 in comparison to the changes in preceding years. Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. In 2018 there were 1,209 HIV cases newly diagnosed in Poland (diagnosis rate: 3.15 per 100,000), including 100 among non-Polish citizens. The frequency of newly detected HIV infections decreased by nearly 14.8% compared to the previous year and was higher by almost 6.8% compared to the median in 2012-2016 years. The total number of AIDS cases was 110 (incidence 0.29 per 100,000), and 23 people died from AIDS disease (0.06 per 100,000). New HIV diagnoses were reported mainly among people in age 30 to 39 years (37.8%) and among men (86.8%). Among cases with known transmission route, 77.0% concerned among men who had sexual contact with men (MSM). However, compared to the previous year, there was a significant decrease in the percentage of infected people in all key populations, related to higher risk of HIV infection. In addition, we observe the drop in total number of infected people in 2018 compared to the previous year. Whether these observations represent just fluctuations or a stable tendency, related to decreasing incidence in different key populations can only be assessed in the following years. The percentage of AIDS cases diagnosed at the same time with HIV diagnosis decreased by 4% percent points in comparison to 2017 (from 75.7% to 71.84% of all incident AIDS cases). Despite the decreasing total number of new HIV diagnoses overall and among different key populations compared to the previous year, it is too early to conclude that these are the results of positive preventive measures. Still, all actions should be taken to ensure timely linkage to care, considering the growing number of infected people among foreigners residing in Poland, and to improve the low frequency of testing towards HIV in the whole population.

HIV and AIDS in Poland in 2017

The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections and AIDS cases and death among AIDS cases in Poland in 2017 in comparison to the changes in preceding years. Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. In 2017 there were 1,419 HIV cases newly diagnosed in Poland (diagnosis rate: 3.69 per 100,000), including 51 among non-Polish citizens. The frequency of newly detected HIV infections increased by nearly 8% compared to the previous year and by almost 28% compared to the median in 2011-2015 years. The total number of AIDS cases was 108 (incidence 0.28 per 100,000), and 20 people died from AIDS disease (0.05 per 100,000). New HIV diagnoses were reported mainly among people in age 20 to 39 years (69.5%) and among men (88.5%). Among cases with known transmission route, 69.5% concerned among men who had sexual contact with men (MSM). The percentage of MSM cases, similarly to heterosexual cases decrease in comparison to previous year, relatively by 5.7% and 6.4%. The percentage of AIDS cases diagnosed at the same time with HIV diagnosis increased by 6% percentage points in comparison with 2016 year (from 68% to 74% AIDS cases). The most HIV cases are diagnosed among MSM, so prophylactic activities are still needed in this key population. It is also need to increase the number of new cases linkage-to-care and to improve the low frequency in HIV testing rate in all population.

BASHH 2016 UK national audit and survey of HIV testing, risk assessment and follow-up: case note audit.

This national audit demonstrated discrepancies between actual practice and that indicated by clinic policies following enquiry about alcohol, recreational drugs and chemsex use. Clinics were more likely to enquire about risk behaviour if this was clinic policy or routine practice. Previous testing was the most common reason for refusing HIV testing, although 33% of men who have sex with men had a prior test of more than three months ago. Of the group declining due to recent exposure in the window period, 21/119 cases had an exposure within the four weeks prior to presentation, but had a previous risk not covered by previous testing. Recommendations include provision of risk assessments for alcohol, recreational drug use and chemsex, documenting reasons for HIV test refusal, provision of HIV point-of-care testing, follow-up for cases at higher risk of HIV and advice about community testing or self-sampling/testing.

A Cross-Sectional Survey of HIV Testing and Prevalence in Twelve Brazilian Correctional Facilities.

BackgroundPrior studies have reported higher HIV prevalence among prisoners than the general population in Brazil, but data have been derived from single prisons. The aim of this study was to evaluate HIV testing practices, prevalence and linkage to care among inmates in a network of 12 prisons.MethodsWe administered a questionnaire to a population-based sample of inmates from 12 prisons in Central-West Brazil and collected sera for HIV and syphilis testing from January to December 2013. We evaluated factors associated with HIV testing and infection using multivariable logistic regression models. Six months after HIV testing, we assessed whether each HIV-infected prisoner was engaged in clinical care and whether they had started antiretroviral therapy.ResultsWe recruited 3,362 inmates, of whom 2,843 (85%) were men from 8 prisons, and 519 (15%) were women from 4 prisons. Forty-five percent of participants reported never having been tested for HIV previously. In multivariable analysis, the variables associated with previous HIV testing were lack of a stable partner (adjusted odds ratio [AOR]: 1.38; 95% CI: 1.18–1.60), completed more than four years of schooling (AOR 1.40; 95% CI: 1.20–1.64), history of previous incarceration (AOR: 1.68; 95% CI: 1.43–1.98), history of mental illness (AOR 1.52; 95% CI: 1.31–1.78) and previous surgery (AOR 1.31; 95% CI: 1.12–1.52). Fifty-four (1.6%) of all participants tested positive for HIV; this included 44 (1.54%) men and 10 (1.92%) women. Among male inmates, HIV infection was associated with homosexuality (AOR 6.20, 95% CI: 1.73–22.22), self-report of mental illness (AOR 2.18, 95% CI: 1.13–4.18), history of sexually transmitted infections (AOR 3.28, 95% CI: 1.64–6.56), and syphilis sero-positivity (AOR 2.54, 95% CI: 1.20–5.39). Among HIV-infected individuals, 34 (63%) were unaware of their HIV status; only 23 of these 34 (68%) newly diagnosed participants could be reached at six month follow-up, and 21 of 23 (91%) were engaged in HIV care.ConclusionsHIV testing rates among prison inmates are low, and the majority of HIV-infected inmates were unaware of their HIV diagnosis. Incarceration can be an opportunity for diagnosis and treatment of HIV among vulnerable populations who have poor access to health services, but further work is needed on transitional HIV care for released inmates.

National HIV prevalence estimates for sub-Saharan Africa: controlling selection bias with Heckman-type selection models

ObjectivesPopulation-based HIV testing surveys have become central to deriving estimates of national HIV prevalence in sub-Saharan Africa. However, limited participation in these surveys can lead to selection bias. We control...

A National Survey of HIV Testing in Intensive Care: Moving Forwards

There is currently no accepted national guideline for HIV testing in intensive care. This survey aimed to determine current HIV testing practices and attitudes to testing in English ICUs. The response rate was 44% from 120 units. There was a wide variation in testing practices in the absence of any ICU-specific HIV testing guidelines. Only 9% of units had written guidelines, and none of the units tested for all HIV-indicator diseases. A majority of units (57%) felt that GMC guidance should be changed to allow universal testing, and almost all (92%) felt that the patient should be tested when a member of staff experienced a needlestick injury. The authors suggest that there is a need for national HIV testing guidelines specific to intensive care.

Exploring HIV Prevention Utilization among Female Sex Workers and Male-to-Female Transgenders

Female sex worker (FSW) and male-to-female transgender (TGW, transgender women) populations both experience elevated levels of HIV infection and have unique prevention needs because of their stigmatized social status and often-precarious economic circumstances. We analyzed data from 104 FSWs and 128 TGW to assess their level of exposure to active and passive HIV prevention services and identify which subgroups are underserved. Data were collected, in Los Angeles for the cross-sectional 2003-2004 HIV Testing Survey (HITS), through face-to-face interviews with participants recruited primarily from street, club, and social service venues. Both groups reported more passive than active prevention exposure, with overall participation less common for FSWs than for TGW. Although some differences were observed between groups, predictors of lower HIV prevention utilization identified in both study populations included African American (versus Hispanic) race/ethnicity, higher household incomes, cohabitation/marriage, and not seeking recent health care. Prevention efforts should increase outreach to these subgroups, tailor programs for those who are African American or partnered, and increase the proportion of FSWs and TGW who periodically engage in active HIV prevention services such as client-centered counseling and small-group interventions to build skills related to safer sex.

Preventing HIV in resource-limited settings: evidence for action, from cross-sectional surveys

The current issue of the International Journal of Epidemiology features seven papers that cover a range of issues that are central to our understanding of the HIV epidemic and its control in resource-limited settings. One cross-sectional study highlights the importance of education as a protective factor against HIV in young South African women, another illustrates the complex relationship between socioeconomic position and HIV infection in Tanzania, and a further prevalence study examines the importance of lack of circumcision as a risk factor in the South Indian state of Andhra Pradesh. Male circumcision is also the topic of a modelling study and an accompanying commentary, which examine the potential long-term impact of male circumcision on HIV prevalence in sub-Saharan Africa. Another article in this issue systematically reviews the risk of HIV transmission from orogenital sex, and the final piece estimates the HIV prevalence in Dehong Prefectrue of Yunnan Province China, which is close to the ‘Golden Triangle’ and has a serious HIV epidemic, fuelled by injection drug use. Almost three decades (and a Nobel prize) after the discovery of the virus, HIV/AIDS continues to be a massive burden in many resource-limited settings. Young people aged 15–24 years account for almost half of all new HIV infections in adults, and subSaharan Africa remains the region most heavily affected by HIV. What can be done to stem the epidemic? Keep them in school, say Pettifor and colleagues, based on a nationally representative sexual behaviour and HIV testing survey in South Africa, which showed that not completing high school was the most important risk factor for HIV infection in young women. The authors focused on women aged 15–24 years who reported to have only one life-time partner, and therefore seemingly were at low risk of infection. The prevalence of HIV-1 infection was nevertheless high: 15.0% compared with 3.8% in men of the same age reporting one life-time partner. Over threequarters of women had not completed high school, and their HIV prevalence was 16.9% compared with 8.6% among the minority of women completing their education (crude odds ratio 2.15). The survey was cross-sectional and it is therefore unclear when women contracted HIV, before or after dropping out of school. Dropping out of school was clearly related to sociodemographic and behavioural factors, but unfortunately we are not told which of the variables included in the multivariable model were responsible for the substantial increase in the odds of infection associated with dropping out (adjusted odds ratio 3.75). The study of Pettifor and colleagues supports the notion that social policies which keep young women in school will have many benefits, including the prevention of HIV infection. Interestingly, a randomized evaluation comparing three school-based HIV/AIDS interventions in Kenya recently showed that reducing the cost of education by paying for school uniforms, but not training teachers in HIV/AIDS education, reduced dropout rates, teen marriages and teen pregnancies. The importance of education is questioned by the data from the 2003/2004 Tanzania HIV/Aids Indicator Survey (THIS). Mshisha and colleagues focussed on sexually active adults and found that while education was not associated with HIV infection, there was a positive association between standard of living and HIV infection: in women, the prevalence of HIV infection increased from 2.7% in the lowest category of the household standard of living index to 14.1% in * Corresponding author. E-mail: egger@ispm.unibe.ch 1 Institute of Social and Preventive Medicine, Finkenhubelweg 11, University of Bern, CH-3012 Bern, Switzerland. 2 Swiss Tropical Institute, Socinstrasse 57, University of Basel, CH-4002 Basel, Switzerland. Published by Oxford University Press on behalf of the International Epidemiological Association

Use of and Exposure to HIV Prevention Programs and Services by Persons at High Risk for HIV

Although HIV information is widely available in this country, little is known about how commonly used HIV prevention activities reach persons at highest risk for HIV. In this paper, we describe the extent to which HIV prevention strategies reach a sample of high-risk persons and whether such exposure correlates with having been tested for HIV. Data are from the 2000 HIV Testing Survey, an anonymous interview study of men who have sex with men (MSM), injection drug users (IDU), and high-risk heterosexuals (HRH), recruited from appropriate venues in seven states and New York City. We report the proportion of persons exposed to three types of interventions: information (media messages, brochures), counseling or skills-building (group counseling, role play, calling an AIDS hotline), and prevention supplies (provision of condoms, bleach kits), stratified by HIV testing status (ever, never). Exposure to information interventions was high among 2491 respondents (85%-96%) and did not differ by testing status. Use of counseling or skills-building interventions varied by testing status for IDU (8% untested versus 41% tested, p < 0.01) and HRH (14% versus 20%, p = 0.03) but not MSM (15% versus 23%, p = 0.08). Among tested IDU, those receiving bleach kits were more likely to report consistent bleach use when injecting with nonsterile needles (25% versus 9%, p = 0.003). Exposure to HIV prevention information is high but exposure to counseling or skills-building interventions is less common and more prevalent among those previously tested. Prevention initiatives should focus on counseling and testing, skills-building, and prevention supplies.

Factors Associated With Recent Sildenafil (Viagra) Use Among Men Who Have Sex With Men in the United States

Previous studies reported associations between sildenafil (Viagra; Pfizer, New York, NY) use and risk behaviors among men who have sex with men (MSM) in limited geographic areas or special populations. The purpose of the present study was to examine Viagra use among a broader MSM population. The 2002 HIV Testing Survey data from MSM recruited at bars in 10 US states was used to examine Viagra use in the 12 months preceding the interview. Independent correlates of Viagra use were identified using logistic regression. Eleven percent (131/1177) of MSM reported recent Viagra use. Users were older (adjusted odds ratios [aOR] = 2.4 to 6.2, 95% CI: 1.2 to 13.6); were more likely be infected with HIV (aOR = 2.0, CI: 1.0 to 3.9); reported more male sex partners (aOR = 2.4 to 2.7, CI: 1.2 to 5.4); were twice as likely to have unprotected anal intercourse with a nonprimary male partner (aOR = 2.1, CI: 1.2 to 3.5); and were 3 times more likely to report illicit drug usage (aOR = 3.1, CI: 1.9 to 5.2). Fifty-three percent (70/131) of Viagra users simultaneously took illicit drugs. Among MSM from numerous US cities, Viagra use is common and is associated with several high-risk behaviors. These findings are consistent with previous reports and emphasize the need for additional prevention counseling for MSM that incorporates messages targeting Viagra usage and risk behavior.

Survey of HIV testing in laboratories in Catalonia [Spain

Survey of HIV testing in laboratories in Catalonia [Spain

Alternative HIV testing methods among populations at high risk for HIV infection.

The purpose of this study was to determine the levels of awareness and use of alternative HIV tests (home collection kit, oral mucosal transudate collection kit, and rapid tests) among people at high risk for HIV infection. Data were collected as part of an anonymous, cross-sectional interview study--the HIV Testing Survey (HITS)--conducted in seven states from September 2000 to February 2001. Three high-risk populations were recruited: men who have sex with men, injection drug users, and high-risk heterosexuals. Respondents were asked about their awareness and use of alternative HIV tests. The overall awareness and use of the alternative tests was limited: 54% of respondents were aware of the home collection kit, 42% were aware of the oral mucosal transudate collection kit test, and 13% were aware of rapid tests. Among those aware of alternative tests, self-reported use of the tests was also low. The most common reasons given for not using alternative HIV tests were: preference for the standard test; concern that the results could be less accurate; and that alternative tests were not offered. The low levels of awareness and use of alternative HIV tests suggest that the potential for promoting testing among individuals at high risk for HIV by encouraging use of alternative HIV tests has not been fully realized. Alternative tests should be made more broadly available and should be accompanied by education about these tests for physicians and people at risk. Educational efforts should be evaluated to determine if promoting alternative HIV tests increases the numbers of people at risk for HIV who are tested.

HIV infection risk, behaviors, and attitudes about testing: are perceptions changing?

People at high risk for HIV infection could be increasing their risk behaviors, especially now that improved treatments for HIV infection are available. The goal was to investigate whether risk behaviors, perceptions of personal risk for HIV infection, and attitudes toward HIV testing among high-risk persons in Oregon differed in 1996 and 1998. Data from the HIV Testing Survey (HITS), a cross-sectional survey administered to HIV-negative men who have sex with men (MSM), heterosexual adults at high-risk for sexually transmitted diseases (STD), and intravenous drug users (IDUs) at high risk for HIV infection in 1996 (HITS-I), were compared with data from a similar group surveyed in 1998 (HITS-II). Proportions of participants reporting specific risk behaviors remained relatively constant in 1996 and 1998. Personal risk of HIV infection was perceived as low by 54% of HITS-II participants and 61.2% of HITS-I participants (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.9-1.7). IDUs in HITS-II were more likely than IDUs in HITS-I to perceive their risk as low (OR, 2.1; 95% CI, 1.2-3.7). Persons at high risk might underestimate their risk for HIV infection while practicing risky behaviors. The prevalence of risk behaviors in these populations could be considered the baseline against which to measure future prevention efforts.

Changes in HIV testing after implementation of name-based HIV case surveillance in New Mexico.

Name-based HIV case surveillance was implemented in New Mexico on January 15, 1998. The objective of the present study was to assess changes in HIV testing patterns after implementation of HIV case surveillance. The timing of the HIV Testing Survey (HITS), developed to gather data on HIV testing patterns among persons at risk for infection through the use of anonymous, cross-sectional surveys,1 offered a natural experiment in New Mexico: HITS-I took place in 1996, before implementation of HIV case surveillance, and HITS-II took place in 1998, after implementation. Participants were men who had sex with men (recruited from gay bars), injection drug users (recruited through street outreach), and heterosexual adults (recruited from a sexually transmitted disease clinic). Participants were required to be 18 years or older and to have been residents of New Mexico for at least 1 year. Study methods have been described in detail elsewhere.2 Fisher exact tests or χ2 tests were conducted to determine whether categorical variables differed significantly in comparisons of HITS-I and HITS-II. Most participants had been tested for HIV at least once: 233 (84%) in HITS-I and 226 (82%) in HITS-II. The percentage of participants tested anonymously was higher in HITS-II (56%) than in HITS-I (45%; P = .001). Concern about confidentiality (as indicated by the statement “You were worried your name would be reported to the government if you were positive”) was cited as a reason for not undergoing testing by 10 (23%) of 44 untested individuals in HITS-I and by 2 (4%) of 49 untested individuals in HITS-II (P = .01). Participants’ most common reasons for not being tested were fear of learning they were HIV positive and the belief that they were HIV negative. The percentage of participants who correctly identified the current HIV surveillance policy was higher in HITS-II (10%) than in HITS-I (3%; P = .001). The proportion of participants who had been tested did not differ among those who knew the policy and those who did not. Overall, reporting policies seemed to be a minor factor in the HIV testing decisions of individuals at risk. The present results help to allay concerns about whether implementing name-based HIV case surveillance serves as a deterrent to HIV testing. Our findings also support the recommendation that states offer anonymous testing to encourage people to learn their HIV serostatus.3 Ongoing assessment of the effect of surveillance policies on HIV testing is needed as more states implement HIV case surveillance.

What happened to home HIV test collection kits? Intent to use kits, actual use, and barriers to use among persons at risk for HIV infection

Through sequential cross-sectional surveys, we examined intent to use home HIV test collection kits, actual use and barriers to use among persons at high risk for HIV infection. Interest in kits was assessed in the 1995-96 HIV Testing Survey (HITS, n=1683). Kit use, knowledge of kits and barriers to use were assessed in the 1998-99 HITS (n=1788), after kits had become widely available. When asked to choose among future testing options, 19% of 1995-96 participants intended to use kits. Untested participants were more likely than previously tested HIV-negative participants to choose kits for their next HIV test (p < 0.001). Among 1998-99 participants, only 24 (1%) had used kits; 46% had never heard of kits. Predictors of not knowing about kits included never having been HIV tested and black or Latino race. Common reasons for not using kits among participants aware of home test kits were concerns about accuracy, lack of in-person counselling and cost. Despite high rates of anticipated use, kits have had minimal impact on the testing behaviour of persons at high risk for HIV infection. Increasing awareness of kits, reducing price and addressing concerns about kit testing procedures may increase kit use, leading to more HIV testing by at-risk individuals.