Determinants of HIV testing among high school students with a history of substance use in the United States, 2007

Background: Substance use is a significant risk factor for HIV. Relatively little is known nationally about the determinants of HIV testing among adolescents who use substances. The objective of this study was to examine the association between HIV testing and health-risk behaviors among high school students with a history of substance use.

Methods: A sub-sample of students with lifetime substance use (n=9477) was selected from the 2007 Youth Risk Behavior Survey, a nationally representative survey of students in grades 9-12. Students reported whether they ever had an HIV test. Risk behaviors assessed included ever having: sexual intercourse, condom use, first sexual intercourse <13 years, multiple sexual partners, forced sexual intercourse, carrying weapons, fighting, and dating violence. Associations between HIV testing and health-risk behaviors were analyzed using backward multivariate logistic regression that controlled for age, sex, and race/ethnicity.

Results: The overall prevalence of HIV testing among high school students was 12.9%, and among substance users was 16.2%. The most significant association for HIV testing was among students who ever had sexual intercourse compared to those who had not (OR=3.07, 95%CI=2.32–4.07). Other associations included violent risk behaviors such as carrying weapons (OR=1.33,95%CI=1.07-1.66), fighting (OR=1.46,95%CI=1.21-1.76), and dating violence (OR=1.29,95%CI=1.04–1.61).

Conclusions: A small proportion of students using substances are tested for HIV. HIV testing was higher among those who engaged in health-risk behaviors and violence. Co-occurring factors should be considered when expanding HIV testing services, and prevention interventions are needed for adolescents with a history of substance use and violence.