HIV/AIDS, Sexually Transmitted Diseases,
Prevention News Update
Centers for Disease Control and Prevention
Repeat HIV Testing, Risk
Behaviors, and HIV Seroconversion Among Young Men Who Have Sex With Men
January 17, 2002
Journal of Acquired Immune Deficiency Syndromes
01.01.02; Vol 29; P 76-85; Duncan A. MacKellar; Linda A. Valleroy; Gina M.
Secura; Brad N. Bartholow; William McFarland; Douglas Shehan; Wesley Ford;
Marlene LaLota; David D. Celentano; Beryl A. Koblin; Lucia V. Torian;
Thomas E. Perdue; and Robert S. Janssen for the Young Men's Survey Study
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.
to other CDC news for May 30, 2001
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This document was provided by the Centers
for Disease Control and Prevention.