Did CDC’s 2006 Revised HIV Testing Recommendations Make a Difference? Evaluation of HIV Testing in the US Household Population, 2003–2010

OBJECTIVE: To examine changes in the prevalence of HIV testing among adults following the Centers for Disease Control and Prevention’s 2006 revised HIV testing recommendations. DESIGN: The 2003–2010 National Health and Nutrition Examination Survey, a nationally representative cross-sectional survey of the noninstitutionalized US population. METHODS: Weighted estimates and multivariable modeling to assess the prevalence of lifetime HIV testing, outside of blood donations, based on 13,975 respondents aged 18–59 years, comparing the 2003–2006 and 2007–2010 National Health and Nutrition Examination Survey. RESULTS: Overall, HIV testing was 42.1% during 2003–2006 and 44.5% during 2007–2010 (P > 0.05). After adjusting for significant predictors in a multivariate model, HIV testing increased from 2003–2006 to 2007–2010 (adjusted odds ratio [aOR] 1.14, P < 0.05), mostly among males (aOR 1.33, P < 0.001) as compared with females (aOR 1.02, P > 0.05). HIV testing also increased significantly among non-Hispanic blacks, heterosexuals, those aged 50–59 years, those without a sexually transmitted infection history, those without health insurance, and those who did not access health care in the past year. HIV testing did not change significantly among high-risk groups, including men who have sex with men, those with a history of injection or illicit drug use, and those with a sexually transmitted infection history. CONCLUSIONS: In multivariate modeling, we found a modest but significant increase in HIV testing overall and among males after publication of the revised recommendations for HIV testing. The significant increase in non–high-risk groups suggests an expansion in generalized HIV testing, as recommended. However, even in 2007–2010, 56% of the US population has never been tested for HIV.