By Michael Smith, North American Correspondent, MedPage Today
Published: January 03, 2012
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Only about one in five sexually active high school students has ever been tested for HIV, CDC researchers reported.
Testing was more common among those who reported a behavior that increases their risk of acquiring the virus, Alexandra Balaji, PhD, and colleagues at the CDC.
But even in those subgroups, less than half of the students reported ever having had an HIV test, the group reported online in Archives of Pediatrics & Adolescent Medicine.
The findings come from an analysis of the 2009 national Youth Risk Behavior Survey, a nationally representative sample of students in grades 9 to 12 who attended public and private schools.
All told, 16,410 students returned usable data and slightly less than half -- 7,591 -- reported ever having had sexual intercourse. Among those, the researchers said, only 22.6% reported that they had been tested at any time for HIV (excluding tests done for blood donation).
The survey also asked a series of questions about risky behaviors, including such things as injection drug use, multiple partners, and condoms.
A multivariable analysis showed that, compared with those who did not report the risky behavior, the odds ratios for being tested were:
- 1.70 among the 3.7% who reported injection drug use (95% CI 1.14 to 2.56)
- 1.43 among the 13.9% who reported ever having been forced to have sex (95% CI 1.19 to 1.72)
- 1.28 among the 36.2% who reported not using a condom during their most recent sexual intercourse (95% CI 1.08 to 1.51)
- 2.32 among the 30.2% who reported four or more lifetime partners (95% CI 1.98 to 2.73)
In no case did the proportion reporting being tested exceed 42%.
The researchers cautioned that the study was cross-sectional, so that the temporal relationship between testing and risk behaviors could not be established.
As well, they noted, the data are self-reported and could have built-in biases, the survey did not ask about same-sex behavior which omits an important risk group, and the results only apply to adolescents attending high school.
The findings are "disturbing," commented Lawrence D'Angelo, MD, of the Children's National Medical Center in Washington, DC, in an accompanying editorial.
He noted that although CDC guidelines recommend HIV testing for all individuals ages 13 to 64 years, the American Academy of Pediatrics guidelines delay routine testing until age 16 and even then only in adolescents who live in communities where the overall prevalence of infection is greater than 0.1%.
Despite current recommendations, however, D'Angelo argued, "quite simply, we are not testing the right people and are not testing them enough."
He urged a more rigorous approach to HIV testing for adolescents, beginning with a universal test at age 13. Testing would be repeated annually in all adolescents at risk for HIV and again universally at 18, regardless of risk behaviors, followed by universal testing every three years afterward.
The study was supported by the CDC. Authors are employees of the agency.
The journal said D'Angelo did not report any potential conflicts.
Primary source: Archives of Pediatrics & Adolescent Medicine
Balaji AB, et al "Association between HIV-related risk behaviors and HIV testing among high school students in the United States, 2009" Arch Pediatr Adolesc Med 2011; DOI: 10.1001/archpediatrics.2011.1131.
Additional source: Archives of Pediatrics & Adolescent Medicine
D'Angelo LJ "When will routine testing for human immunodeficiency virus infection be the routine for adolescents?" Arch Pediatr Adolesc Med 2011; DOI: 10.1001/archpediatrics.2011.1555.