Correlates of barriers to HIV testing: A comparison of immigrant and US born black individuals

Background: HIV/AIDS disproportionately affects black immigrants in the US, and late presentation is common. Now that HIV testing is no longer mandatory for immigration barriers to HIV testing must be addressed. This study was conducted to identify barriers to HIV testing in black immigrants and compare them to barriers in US born black individuals. Methodology: A validated Barriers to HIV Testing Scale was self-administered by 1061 black participants (18-64 years, 57% foreign-born, 51% women) living in Massachusetts in 2010. Scale items captured several sub-domains influencing testing. Composite scores were compared between immigrants and non-immigrants using ANCOVA. A binary response variable was used in logistic regression to determine predictors of barriers. Results: The mean barriers score was higher for immigrants (78.7 vs 74.1 for US-born, p<0.0001). In univariate analysis, less well educated, lower income, non-English speaking immigrants who have lived in the US for a shorter period of time were more likely to have higher barriers to testing. Annual income below $20,000 was associated with approximately 7-fold increase in the odds for greater barriers in immigrants. In adjusted multivariable analysis only low education levels and shorter duration in the US remained significant. For US born individuals, lower educational attainment was the only factor that predicted testing barriers. Conclusion: Black immigrants face more barriers to HIV testing than US born black individuals. These barriers are driven primarily by education level and duration of time in the US. Interventions should be developed to address these barriers, particularly in new arrivals to the US.