Disparities in HIV Testing among Adults with Adverse Childhood Experiences

BACKGROUND: It is estimated that more than 13% of persons 13 years and older living with HIV are unaware of their status. 80 percent of new HIV infections are transmitted by people who are not aware they have HIV or not receiving any HIV care in the US, presenting a major public health concern and stressing the importance of enhanced HIV screening. Adverse Childhood Experiences (ACEs) have been shown to be risk factors for HIV transmission and studying the relationship of ACEs and the likelihood of HIV screening is thus important to explore. METHODS: Using combined data (2019-2021) from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) dataset, adjusted analyses models were constructed to determine the likelihood of adults receiving HIV testing and their past history of ACEs. RESULTS: Overall, compared to individuals reporting no ACES, individuals reporting 1 to 3 ACEs were significantly more likely to be tested for HIV. However, despite higher prevalence of ACEs, significantly higher prevalence of men who have sex with men (MSM) remained unaware of their HIV status. Significant disparities in HIV testing were also observed by socio demographic characteristics. CONCLUSIONS: Healthy People 2030 aims to increase the proportion of persons who know their HIV status to at least 95% by 2025. Our findings highlight the urgent need for targeted interventions that target high risk groups, promote testing benefits, and encourage increased testing among individuals with a history of ACEs. Given the importance of testing to HIV prevention outcomes, more research is needed to unpack the relationship between HIV risk and HIV testing for individuals with a history of childhood adversity. KEY MESSAGES: • New trauma-informed training programs for health care providers are needed to facilitate targeted HIV testing. • Ongoing research is critical to unpack the relationship between HIV risk and HIV testing for individuals with a history of childhood adversity.