HIV infection continues to impact a large number of Americans.  The CDC estimates that over 1.1 million people in this country are now living with HIV and about 50,000 become infected every year[1]. Despite increased availability of HIV testing, it is estimated that 18% of persons who have HIV do not know they are infected[2].  Increased access to HIV testing is important for several reasons: the risk of AIDS-related complications is greatly reduced when HIV infection is detected and treated early; treating pregnant women greatly reduces the chance that their babies will be infected; and persons who are receiving treatment are much less likely to pass the infection to someone else. Using data from Public Health Management Corporation’s Center for Data Innovation and the Community Health Data Base’s 2012 Southeastern Pennsylvania Household Health Survey, this article examines HIV testing behaviors among adults age 18 and older in Southeastern Pennsylvania (SEPA), specifically looking at characteristics among those who have recently been tested for HIV and those who have never been tested.

Adults Tested for HIV within the Past Year

Fewer than one in four (22%) SEPA adults 18 years of age or older have been tested for HIV within the past year, which represents an estimated 690,600 adults in the region.

·         A greater percentage of younger adults have been tested in the past year compared with older adults. For example, 36% of adults 18-39 had an HIV test in the past year compared with 18% of adults age 50-59.

·         Black (42%) and Latino (41 %) adults are more likely than White (14%) and Asian (14%) adults to have been tested in the past year.

·         A greater percentage of adults with less than a high school diploma report having an HIV test within the past year compared with adults with further educational attainment; for example, 36% of adults with less than a high school diploma were tested, as compared with 26% of those with a high school degree and 17% of those with a college degree or more.

·         Two in five (43%) adults identifying as homosexual, gay or lesbian and 35% of adults identifying as bisexual have been tested for HIV in the past year compared with 22% of adults identifying as heterosexual or straight.

·         More than two in five adults (44%) living below 100% of the Federal Poverty Level (FPL) have been tested within the past year, representing approximately 165,000 adults, compared with one in five adults (20%) living at or above 100% of the Federal Poverty Level.

Testing for HIV and Other Preventive Screening Behaviors

Adults who report having an HIV test within the past year also reporting receiving other recommended preventive screenings in the past year.

·         More than three-quarters of women 18 years of age or older who have been tested for HIV in the past year have also received a pap smear (79%) or a clinical breast exam (76%) in the past year.

·         Similarly, more than three-quarters of women 40 years of age or older have been tested for HIV and received a mammogram in the past year (76%).

·         Among men 45 years of age or older, more than six in ten have been tested for HIV and received a prostate exam in the past year (62%).

Adults who have never been tested for HIV report lower levels of preventive screenings in the past year:

·         Half of women (18+) who have never been tested for HIV received a pap smear in the past year (50%); 63% of women (18+) received a clinical breast exam in the past year.

·         More than six in ten women (40+) who have never been tested for HIV received a mammogram in the past year (62%).

·         Finally, more than half of men (45+) who have never been tested for HIV received a prostate exam in the past year (55%).

Demographics of Adults Never Tested for HIV

Nearly one half of adults (47%) age 18 and older in the SEPA region have never been tested for HIV. Those more likely to report never having an HIV test include adults who are:

·    White and Asian: Over one half of White (56%) and Asian (56%) adults have never been tested compared with 30% of Latino and 26% of Black adults. (Figure 1)

·    Educated beyond high school: Adults with a college degree or more are more likely than those with less than a high school education to have never been tested (49% compared with 41% respectively).

·    Heterosexual or straight: Nearly one half (47%) of heterosexual or straight adults have never been tested for HIV compared with 23% of homosexual, gay, or lesbian adults and 20% of bisexual adults. (Figure 1)

·    Living at or above 100% poverty guidelines: One half of adults living at or above 100% of the Federal Poverty Level (50%) have never been tested for HIV compared with one quarter of adults living below 100% of the Federal Poverty Level (27%). (Figure 1)

·    Age 60 or older: Older adults are more likely than younger adults to report never having been tested for HIV: 66% of adults age 60-74 and 81% of adults age 75+ have never been tested compared with 32% of adults age 18-39, 33% of adults age 40-49, and 49% of adults age 50-59.

Access to Care Indicators among Adults Never Tested for HIV

In addition to examining the demographics and socioeconomic status of these adults, it is important to look at the access to a regular source of care, the number of visits to a healthcare professional and/or the emergency room, and the insurance status of adults who have never been tested for HIV.  These data indicate that many adults who have a regular source of care and visited a healthcare professional in the past year have never been tested for HIV.  Adults in Philadelphia and surrounding suburbs who have never been tested for HIV tend to report their health as “good” to “excellent” (85%), have health insurance (91%), have a regular source of care (90%), and have made at least one visit to their doctor or healthcare professional in the past year (87%).

The following data present the differences in access to care among those who have never been tested for HIV:

·    Regular source of care: Nearly half of adults who do not have a regular source of health care (48%) and 42% of adults with a regular source of care have never been tested for HIV. (Figure 2)

·    Healthcare visits: A similar percentage of adults with no visits to a doctor or healthcare professional in the past year and those with one or more visits have never been tested for HIV (43% and 47% respectively).  

·    ER visits: Half of adults who had no visits to the emergency room in the past year have never been tested for HIV (50%) in comparison with 39% of adults who had one or more visits to the ER. (Figure 2)

·    Insurance status: Among uninsured adults 18-64 years of age, nearly three in ten have never been tested for HIV (28%); 42% of insured adults have never been tested. (Figure 2)

Conclusion/Implication of Data Findings

These data show that there is a need for increased awareness about the importance and availability of HIV testing within the SEPA region.  Primary care physician offices are often a logical venue for targeted health messaging and campaigns, and the majority of adults who have never been tested for HIV do have a regular source of care.  In addition, while they also report their health as good to excellent and are less likely to undergo routine, recommended preventive screenings, most adults who have never been tested for HIV have in fact made at least one healthcare visit in the past year. These findings suggest that most adults have at least one healthcare visit during which they could learn more about HIV testing.  Future awareness campaigns in the region should be tailored to a target audience that is educated and older, and should consider selecting additional venues and media channels and that this population uses, such as local supermarkets, retirement communities and senior centers, newspapers, and news websites.

For more information about these findings, please contact Sarah Ingerman at singerman@phmc.org.