HIV/AIDS, Sexually Transmitted Diseases,
Tuberculosis Prevention News Update

Centers for Disease Control and Prevention
January 17, 2002

Since the early 1990s, repeat testing for HIV at publicly funded counseling and testing sites has increased substantially. In 1998, repeat testing accounted for 56 percent of more than 2 million tests performed. Studies of the efficacy of testing and counseling have differing results, with some reporting that repeat testing was commonly used by low-risk persons to confirm negative results. Other surveys suggested that counseling and testing were not effective at reducing HIV acquisition risks. In 1994, an external advisory committee on HIV prevention recommended that the CDC develop guidelines to restrict repeat testing.

To gain further insight about factors associated with repeat testing, including risk for acquiring HIV, the authors analyzed data from the Young Men's Survey (YMS), an HIV prevalence and risk behavior survey of young men who have sex with men (MSM) who attended gay-identified venues in seven US cities between 1994 and 1998.

YMS sampling was applied in each of the seven sites (method described elsewhere), with gay venues that included dance clubs, bars, parks, street locations in gay neighborhoods, businesses, social organizations, bookstores and bathhouses. Individuals were interviewed for eligibility, and once they agreed to participate informed consent was obtained. They were administered a standardized questionnaire, participated in prevention counseling, and blood specimens were obtained for HIV testing. Participants were reimbursed $40 to $50 for their time and were scheduled to receive their test results within two weeks. Various strategies were used to avoid duplicate enrollment. Trained interviewers rated their confidence in the validity of participants' answers after each interview.

Each of the seven sites used the same questionnaire and asked for sociodemographic data, education level, living situation, sexual identity, and source of health care. Questions about HIV testing were asked. Psychological measures were used, as were sexual behavior measures and indices of drug and alcohol use. To evaluate HIV seroconversion, the authors restricted the analysis to participants who reported having never been tested or having last tested HIV-negative. Standard bivariate and multivariate analyses were used on appropriate sets of data.

Of 3,430 participants, 36 percent tested for the first time, 39 percent had tested infrequently (one or two times), and 26 percent had tested repeatedly (more than three times). Compared with young MSM who tested for the first time, the study showed that young MSM who tested repeatedly were more likely to acquire HIV and to report recent high-risk behaviors. Of those who recently engaged in anal sex, 1 of 10 repeat testers had seroconverted. Of the repeat testers who seroconverted, more than three-quarters acquired HIV 1 year or less from their last test. These seroconversions presumably occurred in cities with established HIV public awareness and prevention programs, and after at least six opportunities (two for each of three tests) with providers to discuss how to reduce risks. First-time testers waited a median of 3 years to test after their first anal sex experience, nearly 2 years longer than repeat testers.

The authors viewed the results of the study as pointing to the needs for easier (and earlier) access to counseling and testing and for training of providers to strengthen practices to identify, counsel and test young MSM, as well as to provide enhanced behavioral interventions for those with persistent risk.

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