HIV testing at publicly-funded health-care and non-health-care settings in the United States, 2005-2007

CDC estimates that one-quarter of publicly-funded HIV testing is conducted in non-health-care settings (i.e., HIV counseling and testing centers). HIV testing programs are critical to curbing the epidemic by increasing the proportion of persons aware of their infection, particularly within populations at increased risk and among persons practicing high-risk behaviors.

A national HIV Counseling and Testing System was used to analyze test-level, pooled data from 28 state and local health departments during 2005-2007 for the number of tests and proportion of previously undiagnosed HIV among non-Hispanic blacks, men who have sex with men (MSM), and injection drug-using MSM (MSM-IDU) tested in health-care and non-health-care settings.

Comparing health-care with non-health-care settings during 2005-2007, the number of HIV tests conducted was higher in health-care settings for blacks (1,196,952 vs. 323,381) and MSM-IDU (9,506 vs. 9,389), but lower in health-care settings for MSM (147,230 vs. 184,064). The proportion of previously undiagnosed HIV infections identified was greater in health-care settings for MSM (4.3% vs. 3.4%), but greater in non-health-care settings for blacks (1.8% vs. 1.0%) and MSM-IDU (4.5% vs. 3.5%).

Although fewer HIV tests were conducted in non-health-care settings among blacks and MSM-IDU, a greater proportion of previously undiagnosed infections were identified. Among MSM, despite fewer tests conducted in health-care settings, a greater proportion of previously undiagnosed infections were identified. Prevention programs for blacks should consider expanded testing in non-health-care settings, particularly in venues or communities reaching those at higher risk. Expanded testing should be considered in all settings to reach MSM and MSM-IDU.