HIV tests given to Hispanic clients at sites funded by the Centers for Disease Control and Prevention (CDC) are more likely than those given to whites to have a positive result and to detect previously undiagnosed infection, according to analyses of 2007 data.1 Among Hispanics tested at these sites, the odds of a new diagnosis are associated with an individual’s gender, age and risk category. Most strikingly, those aged 40 and older have a significantly greater risk than teenagers (odds ratios, 6.1–6.4), and men who have sex with men are more likely than individuals reporting potential HIV exposure through heterosexual contact to receive a new diagnosis (6.8).
The analyses used data on HIV tests provided to Hispanics and whites aged 13 and older at sites operated by 30 health departments that receive CDC funding for HIV counseling and testing services; information on both clinical sites (e.g., STD, family planning or prenatal clinics; community health centers; or physician’s offices) and nonclinical sites (e.g., HIV testing and counseling centers) was included. Differences in HIV testing between Hispanics and whites were identified by p values of less than 5%, and predictors of newly diagnosed HIV among Hispanics were assessed in multivariate logistic regression analysis.
Information on 760,093 tests was inclu-ded in the analyses—293,161 provided to Hispanics and 466,932 provided to whites. Tests provided to Hispanics were more likely than those performed on whites to be for women (50% vs. 47%) and for individuals who were at risk of HIV through heterosexual contact (66% vs. 58%). Seventy percent of tests on Hispanics, compared with 67% of those on whites, took place in clinical settings; 92% and 86%, respectively, were conducted confidentially (i.e., personal identifiers were recorded but were not sent to the CDC).
Overall, 1.2% of tests reported for Hispanics and 0.8% of those for whites detected HIV, including 0.8% and 0.6%, respectively, for individuals who said that they had not -previously tested positive; the differences between Hispanics and whites were statistically significant. Eighty-seven percent of test results for Hispanics and 83% of those for whites were reported to the clients, who subsequently received counseling; in 24% and 22% of these cases, respectively, the individuals did not receive their results for at least two weeks.
In the multivariate analysis assessing characteristics associated with a new HIV diagnosis among Hispanics, the most dramatic findings pertained to age and risk category. Compared with 13–19-year-olds, those in their 40s and older clients had a sharply elevated likelihood of having newly identified HIV infection (odds ratios, 6.4 and 6.1, respectively); more moderate, but still substantial, differentials were apparent for those in their 20s (2.6) and 30s (4.0). Men who have sex with men were considerably more likely than individuals at risk of HIV through heterosexual contact to receive a new diagnosis (6.8); injection-drug users also were at increased risk (2.7), as were clients who fit into both of these categories (3.7) and those who reported some other risk factor (1.7). In addition, men were more likely than women to have HIV newly identified (2.0), and clients for whom the type of test facility was unknown had a greater likelihood than those who were tested in a clinical setting (2.0).
The analysts caution that their study is limited by data constraints and that the findings "are not necessarily representative of all CDC-funded HIV testing sites or all Hispanics attending those sites." Moreover, they add that most HIV tests in the United States—and most of those on U.S. Hispanics—take place in private settings. However, they point out that HIV testing among Hispanics has received inadequate research attention and that few studies of HIV testing have specifically examined newly diagnosed infections. Noting the paucity of culturally relevant HIV prevention interventions for Hispanics, they urge that "in areas and settings most affected by HIV, providers…encourage HIV testing among Hispanics and ensure that test results are promptly returned." The use of rapid HIV tests among Hispanics, they conclude, may be one way to identify new cases "at early stages so that [infected individuals] can benefit from appropriate clinical, medical, prevention, and social services."
—D. Hollander