Trends in HIV Testing among U.S. Older Adults Prior to and since Release of CDC's Routine HIV Testing Recommendations: National Findings from the BRFSS
Free accessResearch articleFirst published online September, 2015
Trends in HIV Testing among U.S. Older Adults Prior to and since Release of CDC's Routine HIV Testing Recommendations: National Findings from the BRFSS
This study examined temporal trends in HIV testing among U.S. older adults (50–64 years of age) before and after the release of CDC's routine HIV testing recommendations in 2006.
Methods.
The sample (n=872,797; 51.4% female) comprised 2003–2010 Behavioral Risk Factor Surveillance System respondents in the oldest categories to which the recommendations apply: 50–54 years (34.5%, n=301,519), 55–59 years (34.1%, n=297,865), and 60–64 years (31.3%, n=273,413). We calculated (1) four-year pooled prevalences of past-year HIV testing before and after 2006, when the recommendations were released; and (2) annual prevalences of HIV testing overall and by age category from 2003–2010. Using weighted, multivariable logistic regression analyses, we examined binary (pre- vs. post-recommendations) and annual changes in testing, controlling for covariates. We stratified the data by recent doctor visits, examined racial/ethnic differences, and tested for linear and quadratic temporal trends.
Results.
Overall and within age categories, the pooled prevalence of past-year HIV testing decreased following release of the recommendations (p<0.001). The annual prevalence decreased monotonically from 2003 (5.5%) to 2006 (3.6%) (β=–0.16, p<0.001) and then increased immediately after release of the recommendations, but decreased to 3.7% after 2009 (β=0.01, p<0.001). By race/ethnicity, testing increased over time among non-Hispanic black people only. Annual prevalence also increased among respondents with recent doctor visits.
Conclusion.
CDC's HIV testing recommendations were associated with a reversal in the downward trend in past-year HIV testing among older adults; however, the gains were neither universal nor sustained over time.
References
1.
BransonBMHandsfieldHHLampeMAJanssenRSTaylorAWLyssSB, Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Morb Mortal Wkly Rep2006;55(RR14):1–17.
2.
PaltielADWeinsteinMCKimmelADSeageGRIIILosinaEFreedbergKA, Expanded screening for HIV in the United States—an analysis of cost-effectiveness. N Engl J Med2005;352:586–95.
3.
EmletCA, “You/re awfully old to have this disease”: Experiences of stigma and ageism in adults 50 years and older living with HIV/AIDS. Gerontologist2006;46:781–90.
4.
LekasHMSchrimshawEWSiegelK.Pathways to HIV testing among adults aged fifty and older with HIV/AIDS. AIDS Care2005;17:674–87.
5.
MaesCALouisM.Knowledge of AIDS, perceived risk of AIDS, and at-risk sexual behaviors among older adults. J Am Acad Nurse Pract2003;15:509–16.
6.
MacKellarDAValleroyLASecuraGMBehelSBinghamTCelentanoDD, Unrecognized HIV infection, risk behaviors, and perceptions of risk among young men who have sex with men: Opportunities for advancing HIV prevention in the third decade of HIV/AIDS. J Acquir Immune Defic Syndr2005;38:603–14.
7.
ShouseRLKajeseTHallHIValleryLA, Late HIV testing—34 states, 1996–2005. MMWR Morb Mortal Wkly Rep2009;58(24):661–5.
8.
ZingmondDSWengerNSCrystalSJoyceGFLiuHSambamoorthiU, Circumstances at HIV diagnosis and progression of disease in older HIV-infected Americans. Am J Public Health2001;91:1117–20.
9.
MartinCPFainMJKlotzSA, The older HIV-positive adult: A critical review of the medical literature. Am J Med2008;121:1032–7.
10.
Kaiser Family Foundation. Fact sheet: HIV testing in the United States. Menlo Park (CA): The Henry J. Kaiser Family Foundation; 2012.
11.
ChenMRhodesPHHallHIKilmarxPHBransonBMValleroyLA, Prevalence of undiagnosed HIV infection among persons aged ⩾13 years—National HIV Surveillance System, United States, 2005–2008. MMWR Morb Mortal Wkly Rep2012;61(02):57–64.
12.
HarawaNTLengMKimJCunninghamWE, Racial/ethnic and gender differences among older adults in nonmonogamous partnerships, time spent single, and human immunodeficiency virus testing. Sex Transm Dis2011;38:1110–7.
13.
Kaiser Family Foundation. Survey brief: Views and experiences with HIV testing in the United States. Menlo Park (CA): The Henry J. Kaiser Family Foundation; 2009.
14.
MackKAOryMG, AIDS and older Americans at the end of the twentieth century. J Acquir Immune Defic Syndr2003;33Suppl 2:S68–75.
15.
Centers for Disease Control and Prevention (US). HIV/AIDS among persons aged 50 and older. Atlanta: CDC; 2008.
16.
AndersenRM, A behavioral model of families' use of health services. Chicago: University of Chicago; 1968.
17.
MosenDMWengerNSShapiroMFAndersenRMCunninghamWE, Is access to medical care associated with receipt of HIV testing and counselling?AIDS Care1998;10:617–28.
18.
AndersenRM, Revisiting the behavioral model and access to medical care: Does it matter?J Health Soc Behav1995;36:1–10.
19.
DoshiRKMalebrancheDBowlegLSangaramoorthyT.Health care and HIV testing experiences among black men in the South: Implications for “seek, test, treat, and retain” HIV prevention strategies. AIDS Patient Care STDS2013;27:123–33.
20.
FordCLWallaceSPNewmanPALeeS-JCunninghamWE, Belief in AIDS-related conspiracy theories and mistrust in the government: Relationship with HIV testing among at-risk older adults. Gerontologist2013;53:973–84.
21.
FordCLDanielMEarpJAKaufmanJSGolinCEMillerWC, Perceived everyday racism, residential segregation, and HIV testing among patients at a sexually transmitted disease clinic. Am J Public Health2009;99Suppl 1:S137–43.
22.
Centers for Disease Control and Prevention (US), Public Health Surveillance and Informatics Program Office. Behavioral Risk Factor Surveillance System: History [cited 2015 May 15]. Available from: URL: http://www.cdc.gov/brfss/factsheets/pdf/brfss-history.pdf.
23.
Centers for Disease Control and Prevention (US), American Association of Retired Persons, American Medical Association. Promoting preventive services for adults 50–64: Community and clinical partnerships. Atlanta: National Association of Chronic Disease Directors; 2009.
24.
ShawBAAgahiN.A prospective cohort study of health behavior profiles after age 50 and mortality risk. BMC Public Health2012;12:803.
25.
BorokJGalierPDinolfoMWelgreenSHoffingMDavisJW, Why do older unhealthy drinkers decide to make changes or not in their alcohol consumption? Data from the Healthy Living as You Age study. J Am Geriatr Soc2013;61:1296–302.
26.
KornKLBraubardBI, Analyses using multiple surveys: In: KornKLGraubardBI. Analysis of health surveys. Hoboken (NJ): John Wiley & Sons; 1999. p. 278–303.
27.
StataCorp.Stata$: Version 10/SE for Windows. College Station (TX): StataCorp; 2007.
28.
Van HandelMBransonBM, Monitoring HIV testing in the United States: Consequences of methodology changes to national surveys. PLoS One2015;10:e0125637.
HerrinJWesolowskiLGHeffelfingerJDBostickNHallHIEthridgeSF, HIV screening practices and hospital characteristics in the US, 2009–2010. Public Health Rep2013;128:161–9.
31.
Centers for Disease Control and Prevention (US). HIV testing trends in the United States, 2000–2011. Atlanta: CDC; January 2013.
32.
LiCBalluzLSFordESOkoroCAZhaoGPierannunziC.A comparison of prevalence estimates for selected health indicators and chronic diseases or conditions from the Behavioral Risk Factor Surveillance System, the National Health Interview Survey, and the National Health and Nutrition Examination Survey, 2007–2008. Prev Med2012;54:381–7.
33.
SuttonMYLanierYAWillisLACastellanosTDominguezKFitzpatrickL, Strengthening the network of mentored, underrepresented minority scientists and leaders to reduce HIV-related health disparities. Am J Public Health2013;103:2207–14.
34.
TaverasSDuncanTGentryDGilliamAKimbroughIMinayaJ.The evolution of the CDC HIV prevention capacity-building assistance initiative. J Public Health Manag Pract2007;Suppl:S8–15.
35.
NeedleRHTrotterRT2ndSingerMBatesCPageJBMetzgerD, Rapid assessment of the HIV/AIDS crisis in racial and ethnic minority communities: An approach for timely community interventions. Am J Public Health2003;93:970–9.
36.
FitzpatrickLKSuttonMGreenbergAE, Toward eliminating health disparities in HIV/AIDS: The importance of the minority investigator in addressing scientific gaps in black and Latino communities. J Natl Med Assoc2006;98:1906–11.
37.
EshelAMooreAMishraMWoosterJToledoCUhlG, Community stakeholders' perspectives on the impact of the minority AIDS initiative in strengthening HIV prevention capacity in four communities. Ethn Health2008;13:39–54.
38.
WoosterJEshelAMooreAMishraMToledoCUhlG, Opening up their doors: Perspectives on the involvement of the African American faith community in HIV prevention in four communities. Health Promot Pract2011;12:769–78.
39.
HutchinsonABFarnhamPGDuffyNWolitskiRJSansomSLDooleySW, Return on public health investment: CDC/s Expanded HIV Testing Initiative. J Acquir Immune Defic Syndr2012;59:281–6.
40.
ZuckermanSHaleyJRoubideauxYLillie-BlantonM.Health service access, use, and insurance coverage among American Indians/Alaska Natives and whites: What role does the Indian Health Service play?Am J Public Health2004;94:53–9.
41.
BurkeRCSepkowitzKABernsteinKTKarpatiAMyersJETsoiBW, Why don/t physicians test for HIV? A review of the US literature. AIDS2007;21:1617–24.
42.
DuffusWAWeisKKettingerLStephensTAlbrechtHGibsonJJ, Risk-based HIV testing in South Carolina health care settings failed to identify the majority of infected individuals. AIDS Patient Care STDS2009;23:339–45.
43.
Pub. L. No. 111–148 (2010).
44.
CoonDWLipmanPDOryMG, Designing effective HIV/AIDS social and behavioral interventions for the population of those age 50 and older. J Acquir Immune Defic Syndr2003;33Suppl 2:S194–205.
45.
PhillipsKACataniaJA, Consistency in self-reports of HIV testing: Longitudinal findings from the National AIDS Behavioral Surveys. Public Health Rep1995;110:749–53.
46.
BlumbergSJGaneshNLukeJVGonzalesG.Wireless substitution: State-level estimates from the National Health Interview Survey, 2012. Hyattsville (MD): National Center for Health Statistics (US); 2013.
47.
KeeterSChristianLDimockM.The growing gap between landline and dual frame election polls. Washington: The Pew Research Center for the People and the Press; 2010.
