Shift in the reasons why adults seek HIV testing in the United States: policy implications

HIV testing is an important step in the continuum of HIV care. It provides the opportunity to counsel people who seek testing and links those who test positive to health services. To determine the number of adults who had ever been tested for HIV, compare the reasons they sought testing, and evaluate the policy implications of their decision, data from the 1998 and 2002 National Health Interview Surveys were analyzed. Of 31,138 adults interviewed in 1998, 9728 (31.2%) reported they had been tested for HIV, whereas 10,760 (34.7%) of the 31,044 adults interviewed in 2002 had been tested for HIV. Persons who were interviewed in 1998 and 2002 were similar with regard to sociodemographic characteristics (age, gender, ethnicity, education, and region of origin). The reasons for seeking HIV testing changed between 1998 and 2002. The proportion of adults who were tested for HIV "to find out if infected or not" declined significantly, from 33.9% in 1998 to 11.8% in 2002 (P < .05); the proportion of those who were tested because the HIV test was "part of a routine medical checkup or surgical procedure" increased from 11.4% to 24.6% (P < .05). During the same period, the proportion of adults who ever were tested for HIV because the test was required for health/life insurance, immigration, or military induction decreased slightly, from 14.9% to 14.4%. The increase in testing overall may be explained, in part, by the growing acceptance of routine HIV testing among adults in the United States. While mandatory HIV testing remains controversial, it accounted for 13% to 15% of adults who became aware of their HIV serostatus in 1998 and 2002. This contribution raises questions about its merit in the fight against HIV infection.