HIV testing and immigrants to the US from sub Saharan Africa, the Caribbean and Latin America: Are we missing important groups to target for outreach and intervention?

Background: HIV testing is the first step in the HIV Care Continuum and is a key component of the National HIV/AIDS Strategy.  Among immigrants from mid to high HIV prevalence countries in sub-Saharan Africa, the Caribbean and Latin America, late presentation is common. However, little is known about HIV testing because data are usually aggregated into categories labeled “black” or “Hispanic” without regard to nativity. This study was undertaken to determine the rate and predictors of HIV testing in this population.

Methodology: We used data from the National Health Interview Survey (2007-2010), a nationally representative source of data disaggregated by nativity.  The probability of HIV testing was modeled using multiple logistic regression.   

Results: Among  12,745 immigrants, the majority were from the Caribbean, Central America and Mexico (85%). 4% were from Africa.  85% were Hispanic. 15% were black. A total of 6,756 (53%) had never been tested.  The lowest rate of HIV testing was among Hispanic immigrants (44%). 65% of black immigrants reported testing. Among all immigrants who had not been tested, 62% chose not to because of low self-perceived risk.  Among Hispanic immigrants, those with less education (OR= 0.51, 95%CI (.44, .59)) and lower self-perceived risk (OR=0.18, 95%CI (0.07, 0.41)) were less likely to be tested. Of those who had not been tested, only 15% planned to test in the future.  

Conclusions: Many immigrants from higher HIV prevalence countries have not undergone HIV testing.  Interventions addressing risk perception and increasing awareness, particularly among less well educated individuals, should be developed.