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DURHAM, N.C. -- Since 2000, the rates of HIV testing have
remained relatively low and constant in the United States, with
about one third of Americans ever having had an HIV test, and
less than a quarter of the people considered at high risk for
contracting the virus that causes AIDS report having been
tested in the past year.

The Duke University researchers who conducted an analysis of
testing rates argue that while national HIV testing efforts
have been expanded to include lower risk populations, there is
still untapped potential to increase testing rates among
high-risk individuals.

"We found that high-risk groups want to get tested – but
their actions don't match up with their intentions," said Brian
Wells Pence, Ph.D., an infectious diseases epidemiologist at
Duke University's Center for Health Policy and co-author of a
study appearing early online in the Archives of Internal
Medicine.

The analysis of health surveys of 146,868 Americans showed
that those at high risk for HIV, those who were depressed, and
those who abused alcohol all demonstrated significant gaps
between their intentions to get tested and their actual testing
behavior – an observation that did not hold for lower-risk
groups.

"Recent policy statements emphasize broadening HIV testing
in the general population," Pence said. "But such efforts
should not come at the expense of trying to meet the desire for
testing in higher risk groups. The results of our analysis
suggest that high-risk groups know they should be tested – so
significant potential may still exist to increase testing in
such groups by focusing on access. Patients at alcohol and
mental health treatment sites, for example, may be receptive to
increased testing opportunities."

People at high risk for contracting AIDS include those who
have unprotected sex or who are injection drug abusers.

For their analysis, researchers pooled data collected during
six consecutive annual National Health Interview Surveys,
beginning in 2000. These detailed federal surveys of more than
35,000 households each year cover a wide variety of topics and
are intended to get a "snapshot" of the overall health of the
American population. The Duke researchers focused on a
particular aspect of the survey results -- the difference
between the proportion of individuals reporting an intention to
get an HIV test in the coming year and the proportion that had
been tested in the past year.

The researchers found that overall, rates of actual testing
slightly exceeded rates of planned testing – but the reverse
was true among high-risk groups. Specifically, although 27
percent of those at highest risk said they wanted to be tested
in the next year, only 11 percent had actually sought out a
recent test, Pence said.

"Our analysis suggests that individual and structural
barriers keep some individuals, and especially high-risk
individuals, from translating their testing intentions into
action," Pence said. "Those who lacked a source of primary
health care, for instance, were less likely to act on their
intentions to test. The same was true of individuals who
reported being depressed or abusing alcohol."

In a finding that supports the Center for Disease Control
and Prevention's recommendation that HIV testing be included in
routine medical care, the Duke team found that about 44 percent
of the tests taken during the study period were prompted by
encounters with the health care system, such as prenatal care
visits or other routine medical appointments. The researchers
concluded that the CDC's efforts to incorporate HIV testing in
routine medical care have been successful in making testing
more generally available.

The researchers also found that minority women were
significantly more likely to get tested than white males.

An estimated 1.1 million Americans are infected with HIV,
with about one-quarter of them unaware of their infection. This
minority who do not know their status are believed to be
responsible for over half of new HIV infections in the United
States, making the expansion of HIV testing a top priority for
the CDC.

The Duke analysis was supported by the National Institute of
Alcoholism and Alcohol Abuse. Other team members included Duke
faculty Jan Ostermann and Kathryn Whetten as well as Virender
Kumar of Westat, a Maryland-based contract research
organization.