Priorities for HIV testing in developing countries?

The specificity and sensitivity of human immunodeficiency virus (HIV) antibody tests have increased and their use has expanded in developed and developing countries since 1985. Lately, more expensive rapid (US $3-12/test) and cheaper HIV tests have been proposed. HIV testing by the inexpensive enzyme-linked immunosorbent assays (ELISAs) is often infeasible in developing countries because of the lack of equipment. In 1990, in Kinshasa, Zaire, only about 50% of blood donors were screened for HIV. Counseling before and after testing at centers sponsored by non-governmental organizations is limited in developing countries. HIV testing can lead to discrimination: people have been put in quarantine because they were found to be HIV positive. In regions of high prevalence, high priority testing for blood transfusion is cost beneficial. A positive HIV test would justify the start of treatment for toxoplasmosis in a patient with a focal neurological deficit. In a region of high HIV prevalence, a patient with chronic diarrhea would benefit more from an HIV test than from gastroenterological tests. The absence of facilities for CD4 cell counting makes it impossible to advise symptom-free HIV infected subjects. Prophylactic isoniazid may decrease the incidence of Mycobacterium tuberculosis infection among HIV-infected people but the potential for non-compliance with treatment and the risk that drug resistance will develop exist. Confidential HIV testing plus counseling and condom promotion decreased the incidence of HIV infection and gonorrhea among women living in Kigali, Rwanda. There has been successful counseling of discordant couples with HIV infection in Kigali, Rwanda, and Kinshasa, Zaire. HIV testing in the most cost-beneficial way should be done for both members of a steady couple at the same time. HIV tests should be more available in developing countries, and national guidelines for HIV testing should be set.     

HIV seroprevalence in a London same-day testing clinic

OBJECTIVES: To determine the prevalence of HIV infection among people attending a confidential, non-genitourinary medicine based testing clinic that provides HIV antibody test results on the day of consultation. METHODS: Retrospective analysis of data collected on 2635 individuals attending the Same-Day HIV Testing Clinic at the Royal Free Hospital, London between March 1992 and February 1993. RESULTS: A total of 1612 men and 1023 women were tested for HIV antibody. The primary risk for HIV infection was heterosexual (71.7%; 1889 out of 2635) and homosexual contact (24.5%; 646 out of 2635). Fifty-four individuals were given positive HIV test results (46 men, median age 34 years; eight women, median age 27 years). Overall HIV seroprevalence was 2.0% (95% confidence interval, 1.5-2.5). HIV seroprevalence was highest among homosexual men (6.5%; 41 out of 635) and injecting drug users (5.7%; four out of 70). The rates for heterosexual men and women were 0.2% (two out of 915) and 0.7% (seven out of 974), respectively. Of the 54 individuals who were HIV-antibody-positive, 44 were Centers for Disease Control and Prevention stage II/III, eight stage IV and one was tested at the time of seroconversion (stage I; data were not available for one patient). Of the total numbers attending this clinic 27% (702 out of 2635) had previously been tested and received a negative result. Of a total of 54 HIV-antibody-positive individuals, 40% (21) had previously received a negative test result. CONCLUSIONS: The data suggest that seroprevalence amongst homosexual men attending a designated HIV testing clinic in London is lower than that reported by genitourinary clinic based testing sites. The large number of repeat testers who subsequently became infected with HIV suggests that there is a population requiring specific targetting for HIV risk reduction.     

Risk assessment to improve targeting of HIV counseling and testing services for STD clinic patients

BACKGROUND AND OBJECTIVE: To determine whether self-administered risk assessment could improve targeting of HIV counseling and testing in an STD clinic. STUDY DESIGN: Computerized records from the Prince George's County, Maryland, STD clinic from 1993 through 1996 were used to develop and test models for predicting a positive HIV test. In 1996, a self-administered risk assessment was compared with a counselor's risk assessment of the same patient. RESULTS: Testing the 10% of patients at highest risk would identify 39% of those who were HIV-positive; testing 70% of the patients could identify 92% of those who were HIV-positive. In 1996, 2,288 patients completed the self-administered HIV risk assessment. The same number of HIV-positive persons (7 [28%]) were identified using either self-assessment or face-to-face interview. CONCLUSIONS: Selectively offering voluntary HIV testing based on risk assessment would not be useful because it would miss many infected persons. If prevention counseling cannot be offered to everyone, it could be targeted to those who report a risk by self-assessment.     

Behavioral and psychosocial consequences of HIV antibody counseling and testing with African American women

This study compared a sample of low-income African American women in the southeastern United States who had and had not yet undergone HIV counseling and testing on risk-related cognitive mediating variables and self-reported sexual behaviors. Four hundred sixty (N = 460) African American women were recruited from health clinics and community settings in a southern city. Forty-five percent of the women (n = 207) had undergone HIV counseling and testing, whereas 55% (n = 253) had never been tested. Women who were seropositive were excluded from the analyses. After providing informed consent, the women completed a battery of cognitive mediating measures assessing AIDS knowledge, attitudes theoretically relevant to risk reduction, and self-reported sexual behavior. In addition, each participant demonstrated condom application skills using a penile model. Women who had undergone testing were younger, rated HIV disease as more serious, considered AIDS a greater health concern, had more positive attitudes toward HIV prevention, expressed greater intentions to use condoms, and evidenced a greater commitment to self-protective behavior than women who were not yet tested. Women who had undergone HIV antibody testing, however, showed no differences in sexual behavior from women who were never tested. Sexual behavior, including numbers of partners, frequency of unprotected intercourse, and inconsistent condom use, left women in both groups at significant and comparable risk for HIV and sexually transmitted disease infection. HIV counseling and testing alone may not be effective primary prevention strategies for promoting risk reduction among African American women.     

Tissue specific-distribution and metabolism of vitamin A are affected by dietary protein levels in rats

The prevalence of human immunodeficiency virus (HIV) in adolescents is difficult to assess as few adolescents consent to testing. This prospective study characterized urban youth requesting HIV testing at two types of health settings, inner-city school-based and hospital-based clinics. Data were obtained on 1652 inner-city youths aged 13 to 19 years who consented to individualized HIV counseling and testing from January 1993 to January 1994. Identified risks for HIV included sexual activity, sexually transmitted disease (STD) history, and substance use by self-report during a confidential structured interview. Data were analyzed using chi-squared analysis. Of the 1652 youth who were counseled, 1602 were from hospital-based clinics. A total of 827 (50%) requested HIV testing. Females accounted for the majority of youth who underwent counseling (79%) and requested HIV testing (75%). However, once counseled, males were more likely to be tested. Risk factors differed by gender; females were more likely to report STDs and marijuana use, and males more likely to report alcohol and cocaine use. These results indicate a need to identify developmentally appropriate methods to educate and counsel youth about HIV that will lead to more youth willing to be tested. School-based clinics may provide easier access than traditional health models for confidential HIV services.     

Trillion virion delay: time from testing positive for HIV to presentation for primary care

BACKGROUND: Human immunodeficiency virus (HIV)-infected individuals' initial presentation to medical care frequently occurs at a point of advanced immunosuppression. OBJECTIVES: To investigate the time between HIV testing and presentation to primary care. Also to examine factors associated with delayed presentation. METHODS: One hundred eighty-nine consecutive outpatients without prior primary care for HIV infection were assessed at 2 urban hospitals: Boston City Hospital, Boston, Mass, and Rhode Island Hospital, Providence. Sociodemographics, alcohol and drug use, social support, sexual beliefs and practices, and HIV testing issues were examined in bivariate and multivariate analyses for association with delay in presentation to primary care after positive test results for HIV. RESULTS: Of 189 patients, 74 (39%) delayed seeking primary care for more than 1 year, 61 (32%) delayed for more than 2 years, and 35 (18%) for more than 5 years after an initial positive HIV serologic evaluation. The median CD4+ cell count of subjects was 0.28 x 10(9)/L (range, 0.001-1.71 x 10(9)/L). In multiple linear regression analysis the following characteristics were found to be associated with delayed presentation to primary care after HIV testing: history of injection drug use (P<.001); not having a living mother (P=.01); not having a spouse or partner (P=.08); not being aware of HIV risk before testing (P<.001); and being notified of HIV status by mail or telephone (P=.002). An interaction effect between sex and screening for alcohol abuse was significant (P=.03) and suggested longer delays for men with positive screening test results (CAGE [an alcoholism screening questionnaire containing 4 structured questions], 2+) compared with men without positive screening test results or women. CONCLUSIONS: Patients with positive HIV test results often delay for more than a year before establishing primary medical care. Information readily available at the time of HIV testing concerning substance abuse, social support, and awareness of personal HIV risk status is useful in identifying patients who are at high risk of not linking with primary care. Patients who were notified of their HIV status by mail or telephone delayed considerably longer than those notified in person. Efforts to ensure primary care linkage at the time of notification of positive HIV serostatus are necessary to maximize benefits for both individual and public health and should be an explicit task of posttest counseling.     

Uptake of interventions to reduce mother-to-child transmission of HIV in the United Kingdom and Ireland

OBJECTIVES: To describe the uptake of interventions to reduce mother-to-child transmission of HIV infection. DESIGN: Voluntary confidential reporting of HIV infection in pregnancy and childhood; telephone interview with key professionals in all London maternity units. SUBJECTS AND SETTING: HIV-infected pregnant women and children in the United Kingdom and Ireland. MAIN OUTCOME MEASURES: Trends in breastfeeding, use of zidovudine, mode of delivery and terminations of pregnancy. RESULTS: Between 1990 and 1995, 14 (4%) out of 314 women diagnosed with HIV infection before delivery breastfed compared with 109 (77%) out of 142 diagnosed after delivery. Since 1994, zidovudine use has increased in each 6-month period (14, 39, 67, and 75%; chi 2 = 17.5, P < 0.001), although in 1995 it was the policy of only 48% of London maternity units to offer zidovudine to HIV-infected women. During 1995, 44% of HIV-infected women were delivered by elective Cesarean section. Since 1990, 20% of women first diagnosed in pregnancy were reported to have their pregnancy terminated. CONCLUSIONS: Although detection of previously undiagnosed HIV infection in pregnancy remains low in the United Kingdom, and particularly in London, HIV-infected pregnant women who are aware of their status are increasingly active in taking up interventions to reduce transmission to their infants. If all HIV-infected women attending for antenatal care in London consented to testing and took up interventions and termination of pregnancy at the rates observed in this study, the number of vertically infected babies born in London each year could be reduced from an estimated 41 to 13.     

Improving HIV rapid testing rates among STD clinic patients: A randomized controlled trial.

Objective: The Centers for Disease Control and Prevention recommends that HIV testing be a standard part of medical care; however, testing is voluntary and some patients decline. We evaluated 2 brief interventions to promote rapid HIV testing among STD clinic patients who initially declined testing. Method: Using a randomized controlled trial, patients either viewed an educational digital video disc (DVD) or participated in stage-based behavioral counseling (SBC) provided by a nurse. Sixty clients presenting for care at a STD clinic who initially declined HIV testing at registration and during risk behavior screening participated in the study. Results: The primary outcome was whether patients agreed to be tested for HIV. The secondary outcomes included attitudes, knowledge, and stage-of-change regarding HIV testing. Patients receiving both interventions improved their attitudes and knowledge about testing (ps     

Antenatal HIV antibody testing in Australia

OBJECTIVE: To evaluate the role of voluntary antenatal testing in HIV surveillance and prevention by examining antenatal HIV antibody testing practice and policy in Australia. DESIGN: Cross-sectional study using a self-administered questionnaire. SUBJECTS AND SETTING: Specialist obstetricians and gynaecologists and general practitioners (GPs) affiliated with the Royal Australian College of Obstetricians and Gynaecologists and Australian public hospital antenatal clinics, August-November 1992. MAIN OUTCOME MEASURES: The percentage of public hospital antenatal clinics and specialist and GP obstetricians in Australia who tested pregnant women for HIV antibody as part of their antenatal care, and the proportion of pregnant women in Australia who had an antenatal HIV antibody test in the 1991-92 financial year. RESULTS: Questionnaires concerning antenatal HIV antibody testing were completed by 90% (993/1108) of specialists, 87% (2134/2461) of GPs and 93% (215/230) of public hospitals surveyed. Of the 706 specialists and 1503 GPs who reported that they were currently engaged in obstetric care, approximately 60% (430/706) and 935/1503, respectively) offered antenatal HIV testing either to all pregnant women or to selected groups at risk. There were significant differences in testing patterns between States and Territories. For the 95 public hospitals with antenatal clinics, 81% (77) offered the HIV antibody test to all or selected groups of pregnant women; these percentages did not differ significantly between States and Territories. It was estimated that 25% of pregnant women seen by specialists, 29% seen by GPs and 9% seen in public hospital clinics were tested for HIV antibody as part of their antenatal care in 1991-92. CONCLUSIONS: In Australia approximately one in five pregnant women were tested for HIV antibody as part of their antenatal care in 1991-92. Voluntary HIV testing in pregnancy may provide unrepresentative data for measuring the prevalence of HIV infection in pregnant women.     

Long-term effects of HIV counseling and testing for women: Behavioral and psychological consequences are limited at 18 months posttest.

Behavioral and psychological consequences of HIV counseling and testing (HIV C&T) for women were examined in a longitudinal, prospective study. Women who received HIV C&T at community health clinics (n?=?106) and a comparison group of never-tested women (n?=?54) were interviewed five times over 18 months. There was no change in risk behaviors as a consequence of testing: tested and untested women engaged in high-risk sexual behavior at baseline and 18 months later. Tested women reported more anxiety, depression, and intrusive thoughts about AIDS than did untested women. Although tested women were more concerned about AIDS, their potential risk factors over the study period generally were equivalent to those for untested women. HIV counseling and testing should be considered one aspect of a broader program of HIV prevention. Identification of alternative interventions must be a public health priority. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV risk behaviour and HIV testing of psychiatric patients in Melbourne

OBJECTIVES: Patients with chronic mental illnesses constitute an important risk group for HIV infection overseas. This study aimed to determine the prevalence of risk behaviours associated with HIV transmission and factors associated with HIV testing in psychiatric patients in Melbourne. METHODS: Inpatients and outpatients completed an interviewer-administered questionnaire which covered demographics, psychiatric diagnosis, risk behaviour, and HIV education and testing. RESULTS: Of 145 participants, 60% were male and 55.2% had schizophrenia. Injecting drug use (IDU) was reported by 15.9%, a figure approximately 10 times that found in other population surveys. Most patients reported sex in the last decade and over 20% had multiple sexual partners in the last year. Of males, 12.6% reported sex with another male (9.2% anal sex); 19.0% of females reported sex with a bisexual male. Nearly half of the males reported sex with a prostitute, 2.5 times that in a population sample. Only 15.9% reported ever having someone talk to them specifically about HIV and its transmission, although one-third had been tested for HIV. In multivariate analysis, male-male sex, paying for sex, and IDU were associated with HIV testing, but those whose primary language was not English were less likely to be tested. Those who had received HIV education were more likely to have used a condom last time they had sex (OR 4.52, 95%CI 1.49-14.0). CONCLUSIONS: This study provides evidence that those with serious mental illness in Victoria have higher rates of participation in risk behaviour for HIV infection than those in the general community. Attention to HIV education and prevention in this group has been inappropriately scant; strategies to encourage safer behaviour are urgently needed.     

Investigating the relationship between economic status and HIV risk

Although anecdotal information suggests that there is a relationship between socioeconomic status and HIV risk, there have been few investigations of that possible relationship. Understanding that relationship can have important implications for designing and implementing prevention programs. This study investigated the relationship between indicators of socioeconomic status and HIV prevalence in Massachusetts using seroprevalence data from publicly funded test sites. HIV seroprevalence was found to differ depending on demographic groups and the health care insurance/provider. Those who had no insurance or were Medicaid recipients had higher rates of HIV infection. Homeless individuals were also at higher risk. Further, low-income ZIP codes in Massachusetts were four times more likely to have high seroprevalence rates among residents voluntarily testing for HIV. Thus, HIV seroprevalence appears to be associated with socioeconomic status in this group of voluntarily tested individuals.     

Nature, decay, and spiraling of the effects of fear-inducing arguments and HIV counseling and testing: A meta-analysis of the short- and long-term outcomes of HIV-prevention interventions.

[Correction Notice: An erratum for this article was reported in Vol 26(6) of Health Psychology (see record 2007-16656-022). Several corrections that were omitted are found in this erratum.] Objective: To examine the long-term efficacy of both fear-inducing arguments and HIV counseling and testing at encouraging and maintaining knowledge about HIV transmission and prevention, as well as condom use. Design: Analyses were conducted with a sample of 150 treatment groups and 34 controls and included measures of change at an immediate follow-up and a delayed follow-up. Main outcome measures: The main outcome measures were perceived risk of HIV infection, knowledge about HIV, and condom use. Results: Results indicated that receiving fear-inducing arguments increased perceptions of risk at the immediate follow-up but decreased knowledge and condom use, whereas resolving fear via HIV counseling and testing decreased perceptions of risk and increased knowledge and condom use at both the immediate and delayed follow-ups. The effects on perceived risk and knowledge decreased over time, but the effects on condom use became more pronounced. Conclusion: Inducing fear is not an effective way to promote HIV-relevant learning or condom use either immediately following the intervention or later on. However, HIV counseling and testing can provide an outlet for HIV-related anxiety and, subsequently, gains in both knowledge and behavior change immediately and longitudinally. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV testing among Haitian women: lessons in the recognition of risk

Haitian women in Miami, Florida, responded to recruitment for testing of HIV antibody serostatus in ways that demonstrated the value of ethnographic methods for studying reactions to this kind of test, especially pre- and posttest counseling sessions. A total of 155 women between 14 and 61 years old, recruited in Miami in 1992 and 1993, participated. Response to testing identified three primary obstacles to the women's understanding of content presented in pre- and posttest counseling sessions: (1) their confusion about the meaning of positive versus negative, (2) the investigators' difficulty in communicating the concept of antibody, and (3) vagueness of the concept of window period between exposure and presentation of antibody. Retesting of a subset of Haitian participants helped to define sexual risk among these women in terms of having partners who had other partners and perception of supernatural risk.     

Impact of HIV counselling and testing on HIV seroconversion and reported STD incidence among male factory workers in Harare, Zimbabwe

OBJECTIVES: To assess the impact of HIV counselling and testing on HIV seroconversion and incidence of reported sexually transmitted diseases (STDs) among male factory workers in Harare, Zimbabwe. DESIGN: Prospective, observational study among men recruited to participate in a future workplace based AIDS prevention intervention. METHODS: Participants provided STD histories and blood for HIV antibody testing at enrolment and six month intervals during visits to factories. Participants received HIV test results, post test counselling, and free STD services at the project clinic. RESULTS: Between March 1993 and June 1995, 2,414 men were enrolled with 85% follow up. Overall HIV sero-incidence was 2.60 per 100 person-years; the incidence of reported STDs was 10.19 per 100 person-years. Men who obtained their HIV test results had significantly higher HIV sero-incidence and incidence of reported STDs compared to men who did not obtain their results (IRRs: 1.87, 3.47, respectively). Among men who obtained their HIV test results, a non-significant 40% decrease in HIV sero-incidence was observed after obtaining test results compared to before obtaining results (p = 0.18). The incidence of reported STDs, however, increased by 30% after obtaining HIV test results (p = 0.10). CONCLUSIONS: Decreased HIV sero-incidence in the face of increased reported STD incidence suggests that timely treatment of STDs may decrease the risk of acquiring HIV even in the absence of behaviour change. In populations with high rates of HIV and STDs, the greatest benefit of HIV counselling and testing may be achieved by simultaneously offering STD screening and treatment services.     

Combining HIV and AIDS surveillance: an experience from an Italian region

BACKGROUND: Surveillance systems based on the reporting of AIDS cases do not provide a completely up to date picture of the trend of the HIV epidemic, stressing the need for systems based on the diagnosis of HIV infection. However, implementation of these systems has been hindered by low feasibility, poor access to HIV testing, and problems related to confidentiality. The advantages and disadvantages of the two systems and of combined use were explored by comparing and integrating information from AIDS and HIV testing registries in a region of Northern Italy. METHODS: Linkage of AIDS and HIV testing registries allowed the annual number of incident and prevalent infections to be calculated. For linked cases, concordance of exposure category was determined. RESULTS: Up to the end of 1995, 2186 AIDS cases and 5306 HIV-positive individuals were diagnosed. Linkage identified 1212 individuals reported to both registries. From 1990 to 1995, annual AIDS incidence steadily increased, while incidence of new HIV diagnoses decreased. The AIDS-to-AIDS-free ratio among those infected decreased from 1:5.6 in 1989 to 1:4.2 in 1995. The proportion of women and noninjecting drug users was higher among AIDS-free cases than among AIDS cases. The concordance of the exposure category was high (K = 0.70; 95% CI: 0.67-0.74), but it varied by exposure category; the highest concordance was for injecting drug users. CONCLUSIONS: Integrated use of the information provided by these surveillance systems allowed us to better understand and foresee the AIDS epidemic dynamics. The data also suggested that the reliability of information on exposure category may vary among categories.     

Human immunodeficiency virus (HIV) antigen testing to detect HIV infection in female sex workers in Singapore

Human immunodeficiency virus (HIV) infection is characterised by seroconversion after a ?window? period of 2 to 3 months. After this period antibodies are usually detectable by screening tests (enzyme immunoassay or particle agglutination) confirmed by Western blot analysis. We studied 1000 newly enrolled female sex workers who had not been previously tested for HIV to assess the usefulness of HIV antigen testing to improve the efficacy of HIV infection detection. Blood was taken at enrollment for HIV antigen and HIV antibody testing. The Abbott HIVAG-1 test was used to detect antigen; antibody detection was by the Abbott recombinant HIV-1/HIV-2 3rd generation enzyme immunoassay (EIA) test, the Fujirebio Serodia-HIV particle agglutination (PA) test for screening, and the Diagnostic Biotechnology HIV Blot 2.2 Western blot (WB) test for antibody confirmation. Of the 1000 samples, 26 were positive for HIV antibody testing (26/26 for EIA, 25/25 for PA, 26/26 for WB), giving a prevalence rate of 2.6%, Of these 26 seropositive samples 1 was positive on HIV antigen testing. There were no samples which were antigen-positive and antibody-negative. HIV antigen testing does not add to increased efficacy of HIV detection among female sex workers in Singapore.     

Prevention of vertical HIV transmission with zidovudine: projected impact of HIV testing and prenatal care

We sought to estimate the impact of maternal HIV testing and prenatal care on the potential to reduce vertical transmission through zidovudine (AZT) use by HIV-infected mothers. We evaluated the prepartum maternal HIV diagnosis rate, prenatal care, disease stage, and vertical transmission rate (from a two-part mixture model) using New York State Medicaid and vital statistics data for HIV-infected mothers and their singletons in 1985-90. We used published data to estimate the effect of AZT on vertical transmission and expert input to define other parameters for the model. Our HIV-infected (N = 1514) had a vertical transmission rate of 27.0%. HIV was diagnosed prepartum for 39.5% of women in 1990. Transmission would have been 22.2% if AZT had been taken only by the subset of women diagnosed prepartum with HIV and receiving prenatal care by 34 weeks gestation (86.7%). Transmission would have dropped to 11.2% if all women had been diagnosed prepartum with HIV and received adequate prenatal care. The observed deficiencies in prenatal care and maternal HIV diagnosis rates in this Medicaid population-based cohort must be addressed to realize the promise of AZT to reduce vertical transmission.     

HIV media campaigns and HIV-1 testing trends at London genitourinary medicine clinic, 1985-1993

OBJECTIVE: To describe HIV-related media events in the context of first-time HIV-1-antibody testing trends at a London genitourinary medicine clinic. DESIGN: Demographic and behavioural data were collected prospectively for individuals tested for HIV-1 antibodies between September 1985 and September 1993, at the genitourinary medicine clinic of St Mary's Hospital, London. RESULTS: A total of 19,242 individuals were tested of whom 37% were women. Of the men tested 60% were heterosexual. The women at first time of testing were significantly younger [29.3 years; 95% confidence interval (CI), 28.8-29.7] than the men (32.5 years; 95% CI, 29.2-35.8); mean ages for both sexes did not change significantly over time. Overall, 199 women and 1539 men tested HIV-antibody-positive. The proportions of women testing positive increased significantly over time (chi 2 = 21.7, degrees of freedom = 1; P < 0.001), whereas the proportion of HIV-positive men remained constant for all sexual orientation groups. The proportion of heterosexual women testing positive (2.8%) was similar to the proportion of HIV-positive heterosexual men (2.9%). HIV-positive individuals were significantly older for both sexes. Throughout the study period numerous education campaigns were run using a variety of media complemented by a number of other HIV-related media events. CONCLUSIONS: Peak periods of attendance for HIV testing generally corresponded with increased HIV-related media activity and the greatest testing rates were observed when various HIV media events occurred concurrently. The increase in the number of heterosexuals tested suggests that the risk of heterosexual transmission of HIV has been recognized, at least among older individuals. The exact role of HIV-related media events, including celebrities disclosing their HIV-positive status, remains to be elucidated. Whether the relative under-representation of younger people is due to a lack of awareness, increased use of safer sex practices or reluctance to use the service also remains to be addressed. Given the increasing number of HIV-positive women and the relatively constant rate of HIV-positive tests in the male attendees an urgent need exists to assess the impact and effectiveness of specific HIV media campaigns.     

Women who have sex with other women: HIV seroprevalence in New York State counseling and testing programs

This report provides HIV seroprevalence data for women who are sexually active with women (WSW) choosing to access services in four of New York State's counseling and testing programs from January 1993 to June 1994. During that period, these programs tested 27,370 women. When questioned about sexual activity since 1978, 3.7% of these women reported sexual activity exclusively with women, 5.3% reported sexual activity with both women and men and 90.1% reported sexual activity exclusively with men. HIV seroprevalence in women sexually active exclusively with women in this sample was calculated at 3.0%, at 4.8% in women sexually active with both women and men and at 2.9% in women sexually active exclusively with men. According to the self-reported data in this study, injecting drug use is, by far, the predominant risk factor for seropositive WSW. Significant HIV-related public health/preventative implications for WSW and their service providers are suggested by this data, including the need for prevention education targeted to WSW who are IDUs, the need to provide culturally sensitive education to WSW detailing safer sexual behaviors both with women and with men as well as the need for evaluation of all risk factors when providing risk reduction education to WSW.