Rural Center for AIDS/STD Prevention

RAP Time

(Volume 3, No. 2, February 5, 1999)

Issue Contents

Many Adults Who Perceived High or Medium Risk for HIV Have Not Been Tested

Studies suggest that HIV testing helps reduce HIV transmission. Testing may also provide an opportunity for those infected with HIV to seek early treatment. The prevalence of testing can serve as one measure of prevenion effectiveness. Only a few studies have examined testing among the general adult population.

Sample and Methodology
Data were obtained from the 1993 and 1994 Behavioral Risk Factor Surveillance System, a surveillance system which includes all states and the District of Columbia. The system gathers information on those health behaviors that are primarily related to the leading causes of death from chronic disease. Data are collected monthly via telephone interviews with a random sample of the adult population aged 18 years or older.

Measures in the current analysis included sociodemographic characteristics, health insurance status, perceived general health status, perceived risk for HIV infection, and whether or not the person had been tested for HIV.

Outcomes of the Study
In all, 82,021 persons in 1993 and 84,117 in 1994 provided useful data. The demographic distributions of the samples, which were nearly identical, matched the U.S. population in age, sex, and race/ethnicity.

  • In 1993, 28.3% reported ever being tested for HIV infection for reasons other than blood donaton. In 1994, 38% reported ever having been tested. Hence, testing appears to have become more common.
  • In both years, adults who were younger, black, Hispanic, or male, had higher levels of education, had slightly lower levels of income, and resided in the South or West were more likely than others in their subgroups to have ever been tested.
  • The percentage of respondents who reported voluntary testing rose from 13.8% to 18.5%, and the percentage who reported being tested for other reasons increased from 16.6% to 23.6%.
  • Those at greater risk for HIV were more likely to be tested. However, a substantial proportion of adults who perceived themselves to be a high or medium risk for HIV had not been tested.
  • The prevalence rates of this analysis were similar to other national estimates. Factors found here that signficantly influenced testing were similar to findings from other studies.

Although the results were encouraging, the analysis did reveal that a substantial proportion of adults with perceived risk for HIV infection did not get tested. HIV testing should continue to be encouraged. Knowledge of infection status can help prevent HIV transmission and provide an opportunity for those HIV-infected to seek early treatment. Because rural residents are often isolated from HIV health care, particular efforts should be made to assist rural persons to get tested.

SOURCE: Holtzman, D., et al. (1998). HIV testing behavior and associated characteristics among U.S. adults, 1993 and 1994. AIDS and Behavior, 2, 75-84.

Many Young Women with STD Get Another Infection within Year

This study examined subsequent sexually transmitted infecitons (STI) among adolescent women with chlamydia, gonorreha, and trichomoniasis. Subjects were adolescent women between 15 and 19 years attending clinics in Indianapolis, Indiana.

More than 40% of subjects were later infected by at least one STI within one year. Reinfection was common, but infections with sexually transmitted organisms other than the initial infecting organism were also common. Predictors of subsequent infection were black race, gonorrhea as the initial infection, two or more sex partnters in prior 3 months, and inconsistent condom use. The study suggests the value of comprehensive STI prevention programs for adolescents rather than organism-specific interventions.

SOURCE: Fortenberry, J. D., et al. (1999). Subsequent sexually transmitted infections among adolescent women with genital infection due to Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis. Sexually tranmitted diseases, 26, 26-32.

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Almost One-Half of Adolescent Mothers Do Not Use Condoms

The prevalence of HIV-related risk behaviors among young adolescent mothers (N=58) attending the Rhode Island Hospital Teen-Tot Clinic was assessed. The program delivers primary health care to disadvantaged mothers who deliver when they are less than 16 years of age.

The young mothers of the study had basic knowledge and some personal concern about HIV, but also held common misconceptions about HIV and people with AIDS. Despite their anxiety about HIV, almost half rarely or never protected themselves against HIV by using a condom. Personal concern about HIV was significantly associated with consistency of condom use.

Because of low rates of condom use and substantial rates of multiple sex partners, STDs and second pregnancies, disadvantaged adolescent mothers are at risk of exposure to HIV. Increased personalized concern for HIV may lead to greater motivations for safer behavior for these mothers.

SOURCE: Brown, L. K., et al. (1998). HIV-related attitudes and risk behavior of young adolescent mothers. AIDS Education and Prevention, 10, 565-573.

Increases in Unsafe Sex Found Among MSM in San Francisco

Data from San Francisco surveys of men who have sex with men and STD clinic reports were analyzed. The data show increases of self-reported unprotected anal intercours and rates of rectal gonorrhea from 1994 to 1997. Advances in HIV therapy may lead some to relax safe sex pratices.

SOURCE: CDC. (1999). Increases in unsafe sex and rectal gonorrhea among men who have sex with men--San Francisco, California, 1994-1997. MMWR, 48, 45-48.

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Heterosexual AIDS Epidemic Validated

This study was conducted to verify the mode of exposure to HIV among cases who obtained AIDS via heterosexual contact. Most cases reported with heterosexually acquired AIDS had valid heterosexual risk exposures.

SOURCE: Klevens, R. M., et al. (1999). Is there really a heterosexual AIDS epidemic in the United States? Findings from a multisite validation study, 1992-1995. American Journal of Epidemiology, 149, 1086-1089.