National HIV Testing Day at CDC-Funded HIV Counseling, Testing, and Referral Sites --- United States, 1994--1998

CDC-funded human immunodeficiency virus (HIV) counseling, testing, and referral sites are an integral part of national HIV prevention efforts (1). Voluntary counseling, testing, and referral opportunities are offered to persons at risk for HIV infection at approximately 11,000 sites, including dedicated HIV counseling and testing sites, sexually transmitted disease (STD) clinics, drug-treatment centers, hospitals, and prisons. Services also are offered to women in family planning and prenatal/obstetric clinics to increase HIV prevention efforts among women and decrease the risk for perinatal HIV transmission. To increase use of HIV counseling, testing, and referral services by those at risk for HIV infection, in 1995, the National Association of People with AIDS designated June 27 each year as National HIV Testing Day. This report compares use of CDC-funded counseling, testing, and referral services the week before and the week of June 27 from 1994 through 1998 and documents the importance of a national public health campaign designed to increase knowledge of HIV serostatus.

The HIV Counseling and Testing System (CTS) collects demographic and HIV risk information, laboratory test results, and return for post-test counseling from each HIV test episode in a CDC-funded counseling, testing, and referral site. CTS records contain no personal identifying information and it is not possible to link the results of repeat tests for the same person. Results from the system are summarized as number of HIV testing episodes rather than number of persons tested, and the proportion positive reflects the number of positive tests divided by the number of tests provided.

Data were available for analysis from 43 reporting areas. The observation period included tests conducted the week before National HIV Testing Day and the week of testing day: 79,133 tests (1555 positive) in 1994, 81,903 tests (1474 positive) in 1995, 88,077 tests (1453 positive) in 1996, 77,351 tests (1317 positive) in 1997, and 77,965 tests (1210 positive) in 1998 (Table 1).

In 1994, before the initiation of National HIV Testing Day, the number of HIV tests the week of June 27 was lower than the preceding week (Table 1). From 1995 to 1998, the number of tests during the week of National HIV Testing Day was higher than the preceding week. The overall percentage of HIV-positive tests declined during testing day week compared with the preceding week, primarily because of the higher number of tests reported during the week of testing day, with the exception of 1995 (Table 1). However, each year, the number positive HIV tests was higher the week of National HIV Testing Day than the week before testing day (range: 21--78 additional HIV-positive tests).

Use of CDC-funded HIV counseling, testing, and referral services varied by day of the week, with highest use in each year reported on Mondays through Thursdays, moderate use on Fridays, and lowest use on weekends when most sites are closed. In 1997 and 1998, National HIV Testing Day fell on a Friday and a Saturday, respectively. Despite the usual drop in demand for testing at the end of the week, testing on June 27 represented the highest level of tests reported for a Friday and Saturday in each respective year, with 8455 tests in 1997 (median: 5578.5) and 2707 tests in 1998 (median: 638.5). In 1995 and 1996, National HIV Testing Day fell on a Tuesday and Thursday, respectively, with both days in the top 10 of all Tuesdays and Thursdays in each respective year. The number of tests reported for Monday, June 27, 1994 (the year before initiation of testing day), was below the median number of tests reported for Mondays in 1994 (n=7958; median: 8081).

From 1995 to 1998, during the National HIV Testing Day program, post-test counseling rates were comparable between the 2 weeks. The percentage of all HIV-negative test events with completed post-test counseling ranged from 72.7% to 78.8%, and the percentage of all HIV-positive test events with completed post-test counseling ranged from 80.8% to 85.9%.

Reported by: A Farmer, MBA, National Association of People with AIDS, Washington, DC. Prevention Svcs Research Br and Statistics and Data Management Br, Div of HIV/AIDS Prevention--Surveillance and Epidemiology, and Community Assistance, Planning, and National Partnerships Br, Div of HIV/AIDS Prevention--Intervention Research and Support, National Center for HIV, STD, and TB Prevention, CDC.

Editorial Note:

The findings in this report indicate that from 1995 through 1998, use of CDC-funded HIV counseling, testing, and referral services increased during a national campaign designed to promote knowledge of a person's HIV serostatus. The National Association of People with AIDS, in coordination with other national HIV-prevention partners and AIDS care and service providers, provided campaign and media kits to state and local service providers during each year of the campaign. Social marketing and media tools were designed to increase actual use of counseling, testing, and referral services by those persons already infected with HIV but undiagnosed, and those at risk for acquiring HIV infection. Although the number of testing episodes and HIV-positive tests increased each year of the campaign, the capacity of the facilities providing services was not exceeded. Post-test counseling rates for the 2 weeks were similar, with a higher percentage of post-test services provided when an HIV-positive test was reported.

The findings in this report are subject to at least three limitations. First, because CTS is based on each encounter in an HIV counseling, testing, and referral site, the number of positive tests is not the same as the number of persons who tested positive because some persons may have tested multiple times. However, the number of repeat episodes during a 2-week period probably was small. Second, the population accessing services at publicly funded sites may not be representative of all persons tested for HIV infection during the observation period because most HIV tests are completed in the private sector (2,3). Finally, the choice of the observation time (i.e., the week before test day and the week of test day) was made to minimize the effects of service variation caused by season, day of the week, and holidays. Because some areas initiate information campaigns as early as 3 weeks before National HIV Testing Day, this compressed period may not account for all activity.

The benefits of early knowledge of HIV serostatus are greater now than at any time during the epidemic. For HIV-infected persons, highly active antiretroviral therapy has improved dramatically the quality and duration of life and may reduce the risk for transmission by decreasing viral load (4--6). Reduced HIV transmission also can occur because many infected persons may reduce sexual risk behavior after HIV-infection diagnosis (7). For these reasons, public health programs should work to diagnose HIV infection in each of the approximately 220,000 infected persons (8) who do not know their HIV status, link them to care and prevention services, and assist them in adhering to treatment regimens and in sustaining riskreduction behavior. All HIV counseling, testing, and referral services, in either public or private settings, should be voluntary and confidential. CDC strongly encourages states to include anonymous testing as an integral component of HIV counseling, testing, and referral services.

To increase the number of infected persons who are aware of their HIV status early in the course of their infection, CDC recommends targeting efforts to reach persons at risk for HIV infection in areas with high prevalence. Public health programs should attempt to remove barriers and tailor counseling, testing, and referral services to individual and community needs and preferences (e.g., offering services in nontraditional settings to increase accessibility, expanding clinic/office hours, and using less-invasive specimen collection such as oral fluid).

CDC encourages adults and adolescents to assess their risk for HIV infection on the basis of their past behavior. Persons who believe they might have been exposed to HIV but who have not been tested should seek HIV counseling, testing, and referral services. Additional information about HIV prevention services is available on the World-Wide Web at http://www.hivtest.org* or from the National AIDS Hotline, telephone (800) 3422437.

References

1. Valdiserri RO. HIV counseling and testing: its evolving role in HIV prevention. AIDS Edu Prev 1997;9:2--13.
2. Tao G, Branson BM, Kassler WJ, Cohen RA. Rates of receiving HIV test results: data from the U.S. National Health Interview Survey for 1994 and 1995. J Acquir Immune Defic Syndr 1999; 22:395--400.
3. CDC. HIV counseling and testing in publicly funded sites: 1996 summary report. Atlanta, Georgia: US Department of Health and Human Services, CDC, 1998.
4. Palella FJ, Delaney KM, Moorman AC. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med 1998;338:853--60.
5. Gupta P, Mellors J, Kingsley L, et al. High viral load in semen of human immunodeficiency virus type 1infected men at all stages of disease and its reduction by therapy with protease and nonnucleoside reverse transcriptase inhibitors. J Virol 1997;71:6271--5.
6. Vernazza PL, Gilliam BL, Flepp M, et al. Effect of antiviral treatment on shedding of HIV-1 in semen. AIDS 1997;11:1249--54.
7. Denning P, Nakashima A, Wortley P, the SHAS Project Group. High-risk sexual behaviors among HIV-infected adolescents and young adults [Abstract]. In: Program and Abstracts of the 6th Conference on Retroviruses and Opportunistic Infections. Chicago, Illinois: Foundation for Retrovirology and Human Health, 1999.
8. Sweeney PA, Fleming PL, Karon JM, Ward JW. A minimum estimate of the number of living HIV infected persons confidentially tested in the United States [Abstract]. In: Program and Abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy. Toronto, Canada: American Society of Microbiology, 1997.

* References to sites of non-CDC organizations on the World-Wide Web are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites.

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