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.