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PubMed2006

Recent HIV testing among young men who have sex with men: correlates, contexts, and HIV seroconversion.

OBJECTIVES: We evaluated the correlates and contexts of HIV testing within the past year, subsequent risk reduction, and HIV seroconversion among young men who have sex with men (MSM). METHODS: Young men aged 23 to 29 years were approached, interviewed, counseled, and tested for HIV at 181 randomly sampled MSM-identified venues in six U.S. cities from 1998 through 2000. Analyses were restricted to 2,797 MSM who reported never testing HIV-positive. RESULTS: Of the 2,797 MSM, 1,281 (46%) either never previously tested or had not tested in the past year (never/remote testers); 1,516 (54%) had tested in the past year (recent testers); and 271 (10%) tested HIV-positive as part of the study. Of 1,885 recent sex partners reported by HIV-infected participants, 68% were partners of never/remote testers. Of recent testers, 50% tested anonymously, 51% tested because of specific risks, 59% were counseled, 47% reported reducing their risks after testing, and 8% tested HIV-positive (percent HIV-infected by race: blacks, 24%; Hispanics, 6%; whites, 4%; Asians, 1%). CONCLUSION: Nearly half of young MSM participants had not tested in the past year and HIV-infected never/remote testers accounted for approximately two thirds of recent partners potentially exposed to HIV. Of those who had tested recently, many MSM, especially those who are black, had already acquired HIV. To reduce HIV transmission and facilitate early diagnosis and entry into care, increased HIV testing among young at-risk MSM in the United States, especially those who are black, is needed.

AIDS Serodiagnosis↗
PubMed1991

Prevalence of HIV infection in childbearing women in the United States. Surveillance using newborn blood samples.

A national, population-based survey was initiated in 1988 to measure the prevalence of human immunodeficiency virus (HIV) infection in women giving birth to infants in the United States. Following standardized procedures, residual dried-blood specimens collected on filter paper for newborn metabolic screening were tested anonymously in state public health laboratories for maternal antibody to HIV. As of September 1990, annual survey data were available from 38 states and the District of Columbia. The highest HIV seroprevalence rates were observed in New York (5.8 per 1000), the District of Columbia (5.5 per 1000), New Jersey (4.9 per 1000), and Florida (4.5 per 1000). Nationwide, an estimated 1.5 per 1000 women giving birth to infants in 1989 were infected with HIV. Assuming a perinatal transmission rate of 30%, we estimate that approximately 1800 newborns acquired HIV infection during one 12-month period. Preventing transmission of HIV infection to women and infants is an urgent public health priority.

Anonymous Testing↗
PubMed2003

Risk factors for incident HIV infection among anonymous HIV testing site clients in Santos, Brazil: 1996-1999.

OBJECTIVES: To determine temporal trends in HIV infection and risk factors among persons seeking anonymous HIV testing in Santos, Brazil. METHODS: Data and sera from persons testing for HIV from 1996 to 1999 were used. Exposures were abstracted from HIV testing risk assessments. Stored HIV-positive sera were tested to identify recently acquired HIV infection using a serologic testing algorithm for detecting recent HIV seroconversion (STARHS). Independent associations between exposures and recently acquired HIV infection were determined using multivariate analyses. RESULTS: Overall, estimated HIV incidence was 2.0% (95% CI: 1.1-3.5) for the 4-year period: 1.2% (95% CI: 0.5-2.6) in women and 2.7% (95% CI: 1.3-5.0) in men. Incidence increased among women but remained stable among men. Exposures independently associated with incident infection included a history of sex work (OR= 5.4, 95% CI: 1.5-18.7), concurrent syphilis infection (OR =4.1, 95% CI: 1.4-11.9), anal sex (OR = 3.0, 95% CI: 1.3-7.1), and having an HIV-positive sexual partner (OR= 1.4, 95% CI: 1.1-1.9). CONCLUSIONS: This study further demonstrates the public health utility of using the STARHS for the assessment of emerging trends in the HIV epidemic. Results from this study will help to target appropriate prevention strategies directed toward at-risk populations in Santos.

Adult↗
PubMed1998

Anonymous unlinked testing as a sentinel approach: experience in Germany.

STUDY OBJECTIVE: To establish a laboratory sentinel as a supplementary instrument for monitoring the seroprevalence of HIV among childbearing women as a proxy to the heterosexually active population. DESIGN/SETTING: Anonymous unlinked testing of neonatal dried blood spots has been performed in central laboratories of three federal states since 1993. The survey uses residual dried blood spots collected on Guthrie cards for screening of infants for metabolic disorders. These are eluted and tested for HIV antibodies. Data retained with the specimen are only district of residence along with year and month of birth. PARTICIPANTS: Because maternal IgG crosses the placenta before birth, the presence of antibodies in newborns reflects the infection status of the mother. Childbearing women are fairly representative for the heterosexually active general population. MAIN RESULTS: The observed HIV prevalence in childbearing women of less than 1 per thousand confirms the assumption of a low rate of HIV infection in the general population. Significant time trends could not be detected, but HIV prevalence was higher in metropolitan compared with rural areas. CONCLUSIONS: Laboratory sentinels in general and the anonymous unlinked testing of neonatal dried blood spots in particular can supply additional information on HIV seroprevalence. This surveillance system could be expanded to utilise residual samples of other sources as well as to monitor the immunity against specific vaccine preventable diseases and other infectious diseases of public health relevance.

Adolescent↗
PubMed1998

Sexual practices among men attending an anonymous HIV testing site in Singapore.

This study was undertaken to provide an empirical basis for planning safer sex interventions in Singapore by examining the sexual practices of men attending an anonymous HIV testing site. All male clients attending the testing site from January, 1996 to January 1997 were asked to complete an anonymous questionnaire concerning oral and anal sex with men as well as vaginal, oral and anal sex with women within the past year. Questionnaires were obtained from 251 male clients, ranging in age from 17 to 70 years (mean = 30.3). Of these 50.6% reported sex with women only, 39% with men only, 7.2% with both men and women and 3.2% with no one. Condom use was moderately high for anal and vaginal sex but low for oral sex. A risk index based on the riskiness of specific activities showed that bisexuals were the most likely to engage in high risk behaviour whereas homosexuals were the least likely. One factor in the greater riskiness of bisexuals' behaviour appeared to be a higher frequency of unprotected sex with women. These findings provide a preliminary portrait of sexual risk-taking among men in Singapore and suggest the need for continued emphasis on consistent condom use for penetrative sex as well as appropriate precautions for oral sex. The results also suggest the need to develop targeted interventions for bisexuals, particularly with respect to unprotected sex with women.

Adolescent↗
PubMed1991

Voluntary antenatal HIV testing--results of a pilot study.

Voluntary testing for antibody to human immunodeficiency virus (HIV) was offered to 4929 antenatal patients attending two hospitals in South Manchester during a 12 month period in 1989/90 in order to assess the feasibility of obtaining seroprevalence data by this method. Of these patients, 1728 (35%) agreed to a named test, 1396 (28%) to an unlinked anonymous test and the remaining 37% declined to be tested. The proportion of women tested increased from 22% to 88% over the period, and was similar in those with and without an identified risk factor for infection. One HIV antibody positive patient was found; she was tested anonymously and had no identified risk. The substantial cost in time and money required to establish the universal voluntary testing programme and the incomplete patient compliance confirm the importance of the unlinked anonymous surveys currently being established in the UK to monitor seroprevalence in sentinel populations.

AIDS Serodiagnosis↗
PubMed1997

Anonymous HIV testing using home collection and telemedicine counseling. A multicenter evaluation.

BACKGROUND: Home human immunodeficiency virus (HIV) testing has been proposed as an alternative to conventional HIV testing. Despite debate over HIV type 1 (HIV-1) home test systems, these concerns have not to our knowledge been previously studied. OBJECTIVE: To evaluate the safety and efficacy of the Home Access Health Corp (Hoffman Estates, Ill) HIV-1 test system compared with traditional HIV-1 testing with venous blood. METHODS: A total of 1255 subjects were studied prospectively in a blinded, subject-as-control evaluation at 9 outpatient clinics using intent-to-treat analysis. Subjects were provided a home collection kit (Home Access Health Corp) to collect their own finger-stick blood spot samples for laboratory analysis. Subjects received pretest counseling by telephone and their comprehension was subsequently assessed. Subject-collected blood spot samples were compared with professionally drawn blood spot samples for adequacy (sufficient for completing the Food and Drug Administration-endorsed testing) and with venous samples for accuracy. Subjects called 3 days later for anonymous results and posttest counseling. Device safety was evaluated based on adverse events incidence. Subject comprehension of HIV information was measured. RESULTS: Subject-collected blood spot sample results were in complete agreement with venous blood sample results, demonstrating 100% sensitivity and 100% specificity compared with venous controls. Ninety-eight percent of subjects obtained testable blood spot specimens compared with phlebotomists. Following pretest counseling, subjects answered 96% of HIV risk questions correctly. There were no significant adverse events. CONCLUSION: Anonymous HIV-1 home collection kits with pretest and posttest telephone counseling can provide a safe and effective alternative to conventional venous HIV-1 antibody testing.

Adult↗
PubMed1996

Anonymous HIV testing in the Canadian aboriginal population.

Reported numbers of acquired immunodeficiency syndrome cases among Canadian aboriginal peoples are currently relatively low. However, any increase in these numbers could have devastating human, social, and economic costs. Education and prevention of human immunodeficiency virus transmission are the most efficient and cost-effective measures available today. This paper discusses the role of anonymous HIV testing in effective HIV prevention in the Canadian aboriginal population.

Canada↗
PubMed1996

Attitudes to prenatal testing and notification for HIV infection in Nairobi, Kenya.

Four hundred antenatal clinic attendants were surveyed for their attitude to testing and notification for HIV infection test results. The participants were systematically sampled from the antenatal clinic at the Kenyatta National Hospital, Nairobi, and interviewed using a closed-ended structured questionnaire. All the attendants had heard of HIV, and only 5(1.3%) did not know how Acquired Immunodeficiency Syndrome (AIDS) presents. Fifty one percent of them had no objection to their blood being tested for HIV. In fact, 52.5% thought, wrongly, that blood was routinely tested for HIV at the hospital's antenatal clinic. More than one third (35.8%) of respondents wished their permission to be obtained before the testing and 95% wished to be informed of the test result. Acceptability of testing was 33.8%, for Named Voluntary Testing, 62.0% for Universal Testing and 1.0% for Anonymous Testing. All the women said they would want to use a method of contraception, principally tubal ligation, if found HIV seropositive and 63.7% would seek a termination of pregnancy. In this study population, acceptability and expressed willingness to know HIV test results and willingness to let a spouse/sexual partner know the result was high. This paper makes recommendations that HIV testing be made available at the ANC, together with competent pre and post-test counselling.

Adolescent↗
PubMed1997

Comparison of patients refusing with patients accepting unlinked anonymous HIV testing in an outpatient STD department in The Netherlands.

From 1 February 1993 to 1 February 1994 all new patients, known patients with new problems, and prostitutes attending the Outpatient Department of Sexually Transmitted Diseases (STD) of the University Hospital Rotterdam were asked to participate in unlinked anonymous human immunodeficiency virus (HIV) testing and to answer some questions. Data from the medical records of 300 patients refusing to participate were compared with self-reported data obtained from 2701 people accepting, to verify if the HIV seroprevalence among accepters could be representative for all STD department visitors. Men refusing were more often of foreign origin, had more often had more than one partner during the previous 6 months, more often attended the STD department for the first time, and more often had an STD diagnosed than men accepting. Women refusing were more often of foreign origin, had less often had more than one partner during the previous 6 months, and had more often used drugs intravenously than women accepting. Because most findings associated with refusing are also associated with being infected with HIV, the HIV seroprevalence among refusers is likely to be higher than among accepters. We therefore advise unlinked anonymous HIV testing of all patients visiting an STD department.

Adult↗
PubMed1993

[Utilization of anonymous HIV testing by the federal health office--developments and motives].

In the state-run health office in Ulm a survey of the frequency of anonymous HIV-antibody tests was taken between 1985 to 1991, of the age and gender representation from 1988 to 1991, of the test motives from 1.1.1990 to 1.3.1991. The result was a regressive trend following the test boom of 1987 and 1988, which is becoming more and more stable. The relation of men and women has been amounting to 6:4 in the last four years; the proportion of women receding slightly but constantly. The main motive of being tested was finding out about a high-risk or potentially high-risk sexual contact, mostly at the beginning of a new partnership. The motive ranking second in frequency was the investigation of the consequences of blood exposure, mostly relating to medical work. The third place was taken by irrational anxieties as a test motive. The article discusses the fact that test at the beginning of a new partnership frequently have the meaning of a sacrifice and a symbol of bondage in combination with a vow to be faithful. In case of irrational anxieties about AIDS the test-counsellor gets a chance to diagnose a possibly neurotic development at a very early stage, so that painful and expensive chronification and generalisation could be stopped or eased.

AIDS Serodiagnosis↗
PubMed1998

Early mortality of undiagnosed but prevalent (in 1983-1984) HIV infection in Lothian injectors who tested hepatitis B surface antigen positive (group A) or negative but were high risk for blood-borne virus transmission (group B) in 1983-1984.

OBJECTIVE: To estimate the early death-rate in HIV infected injectors whose HIV infection was during the injection-related HIV outbreak in Lothian region in Scotland in 1983-1984, which was coincident with Hepatitis B transmissions. SETTING: Regional Virus Laboratory in Edinburgh. SAMPLES: Sera from 1983-1984, originally received for Hepatitis B surface antigen testing, from individuals aged 15-55 years who were positive for Hepatitis B surface antigen in 1983-1984 (group A: census) or tested negative but were at high risk for blood-borne virus transmission according to their reason for testing (group B: 50% sample). METHODS: Survival status of individuals in groups A and B who had not been diagnosed with HIV disease by the end of December 1995 was checked against the deaths' records of the Registrar General for Scotland. Stored sera from 1983-1984 for patients who had died early (that is: in 1983-1984) were tested anonymously for HIV and Hepatitis C antibodies; and prior to testing, causes of death were scored by RPB according to the likelihood of their being HIV or drugs related. RESULTS: Three early deaths were found in group A patients who were not known to be HIV infected. None of the deaths was likely to be HIV-related; the sera were not tested in order not to risk deductive disclosure. Twenty-four early deaths were found in group B patients who were not known to be HIV-infected, five of whom were both HIV and Hepatitis C antibody positive, and one other was HIV antibody negative but Hepatitis C positive. Reclassification after unlinked anonymous testing and multiplying up of the group B results (to account for 50% sample) gave the early death rate (that is: in 1983-1986) as 15/155 (10%) for HIV-infected drug users (95% CI: 6%-13%). CONCLUSION: Injection-related outbreaks of HIV infection in Lothian in 1983-1984 and at Glenochil Prison in 1993 were each associated with substantial--estimated 10%--early death-rate in HIV-infected injectors. Both HIV outbreaks were coincident with Hepatitis B transmissions, which may be relevant. Further investigations of the death-rate within 2 years of HIV infection are warranted in other exposure categories than injection-related and for injectors who have been immunized against Hepatitis B.

Adolescent↗
PubMed1997

On-site, rapid HIV testing with same-day results and counseling.

BACKGROUND: New rapid HIV antibody tests have allowed provision of results and result-specific counseling on the day on initial visit, and have the potential to increase the efficiency of HIV counseling and testing. METHODS: To evaluate the use of rapid testing with same-day results in public clinics, the Single Use Diagnostic System HIV-1 rapid assay was used for a 3-month period at an anonymous testing clinic and a sexually transmitted disease (STD) clinic in Dallas, Texas. Non-reactive rapid test results were reported as HIV-negative. Reactive results were reported as 'preliminary positive'. These procedures were compared with standard testing during a baseline period, with respect to number of clients receiving results and post-test counseling, client satisfaction, counselor acceptance, cost and effectiveness at reducing HIV risk. RESULTS: Rapid testing resulted in an increase in the number of persons learning their serostatus: a 4% increase for uninfected and a 16% increase for infected clients at the Anonymous Testing Clinic; a 210% increase for uninfected patients and a 23% increase for infected patients at the STD clinic. Rapid testing resulted in a cost saving of US$ 11 per test in both the anonymous and STD clinics. Of those previously tested, 88% responded that they preferred the rapid test. In the year following initial HIV test, clients tested with rapid and standard procedures were equally likely to return to the clinic with a new STD (odds ratio, 0.97; 95% confidence interval, 0.7-1.4). CONCLUSIONS: Rapid, on-site HIV testing was feasible, preferred by clients, and, resulted in significant improvement in the number of persons learning their serostatus, without increasing the costs or decreasing the effectiveness of counseling and testing.

Counseling↗
PubMed2006

Assessment of the decision support needs of women from HIV endemic countries regarding voluntary HIV testing in Canada.

OBJECTIVE: To describe the decision support needs of immigrant and refugee women from HIV endemic countries regarding decision-making about voluntary counseling and testing for HIV (VCT) in Canada; and the needs of practitioners who support these women in making this decision, in a culturally appropriate manner. METHODS: Adapted, semi-structured questionnaires, based on the Ottawa Decision Support Framework (ODSF), were used to interview practitioners and patients. Practitioners from diverse backgrounds were purposefully selected from centers providing VCT in Ottawa. Adult, English-speaking immigrant and refugee women from HIV endemic countries were recruited from a clinic specializing in immigrant health services. Responses were tabulated using descriptive statistics, and emerging themes coded to identify unique factors affecting decision-making. RESULTS: Analysis revealed differences between practitioner and patient perceptions of the decision-making needs of women from HIV endemic countries regarding VCT. Practitioners identified women's lack of knowledge about HIV transmission and prevention as a primary need, while patients identified inadequate awareness of HIV screening and treatment services, and their benefits and harms. Patients also perceived that women would not be aware of the various VCT options, while few practitioners highlighted this concern. Both groups held similar viewpoints about counseling strategies that could improve decision-making. CONCLUSION: Women were unaware of the options available to them for VCT. Both practitioners and patients highlighted the issue of stigma and negative outcomes associated with testing that created barriers or contributed to delays in women receiving testing. Women preferred anonymous testing, and recommended that information and decision support regarding HIV testing be provided via non-targeted strategies, and integrated within general health services or public education. PRACTICE IMPLICATIONS: Decision support in the context of VCT can improve decision quality, empowering patients to make informed decisions based on personal values. Study findings can inform the development of clinical guidelines for the routine offering of VCT.

AIDS Serodiagnosis↗
PubMedDate not supplied

Testing for human immunodeficiency virus in chemical dependence treatment programs.

This article examines the issue of testing for human immunodeficiency virus (HIV) in chemical dependence treatment programs. Three types of treatment programs are considered: 21- to 28-day inpatient, eight-week outpatient, and methadone maintenance. Through discussion by groups of chemical dependence treatment providers, recommendations are made in regard to issues of who to test, when to test, confidential versus anonymous testing, charting policies, informed consent, elements of pre- and posttest counseling, and the duty to warn others.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Evaluation of a hospital admission HIV antibody voluntary screening program.

Voluntary screening for the presence of human immunodeficiency virus (HIV) is recommended by the healthcare profession. The optimal settings to accomplish screening have not been established. We evaluated an admission HIV screening program in a large private hospital to assess advantages and disadvantages in this setting. In a three-month study period, 4,535 of 8,868 patients (51%) admitted to the hospital agreed to HIV testing. Serum specimens from 500 patients who refused testing were blindly, anonymously tested. The seroprevalence of the patients agreeing to (0.26%) and refusing (0.60%) testing was not statistically different (p = .12). There were 12 HIV cases discovered; ten (83%) of these were known to be in a high-risk group at the time of admission. Eighty-five percent of patients interviewed were in favor of this screening program. Difficulties associated with confidentiality or consent were not evident. Calculated charges of testing for each HIV case discovery was $14,550. There was no evidence that this screening program provided for a more effective infection control policy to prevent nosocomial HIV transmission. A hospital admission HIV screening program can be implemented, can meet with favorable patient opinion and can detect previously unknown HIV-positive patients. Hospitals are an efficient and practical setting for HIV testing. The benefit of this program appears to be greater for the patient than hospital or healthcare worker. Cost-benefit analyses will identify optimal candidates to be screened in different hospital populations.

Attitude to Health↗