Purpose and Background

The Expanded Testing Initiative aimed to increase the reach of HIV testing to disproportionately affected populations, including African Americans, Hispanics, men who have sex with men (MSM) and injection drug users (IDU) regardless of race or ethnicity. PS07-768 Expanded and Integrated Human Immunodeficiency Virus (HIV) Testing for Populations Disproportionately Affected by HIV, Primarily African Americans (October 2007 through September 2010), focused on the expansion of HIV testing to African Americans with emphasis on supporting the 2006 Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. Funding for PS07-768 was awarded to the 25 jurisdictions with the highest burden of AIDS cases among African Americans.

Epidemiology of HIV and HIV Testing among African Americans

As of 2008, the Centers for Disease Control and Prevention (CDC) estimates that of the 1.2 million persons living with HIV, over 500,000 are African American.¹ Although African Americans represent only 13.6% of the US population, in 2009, they accounted for 52% of HIV diagnoses and 44% of new infections, with a new infection rate 7.7 times that of whites in the US.^2,3 The HIV prevalence rate for black women is 18 times that for white women, and the HIV prevalence rate for black men is six times that for white men.4 Furthermore, the burden of HIV is greater among some subpopulations. For example, in 2009, when examining behavioral risk groups by age, black MSM aged 13-29 years accounted for 66% of all new HIV infections among blacks.³

CDC estimates that about 21% of infections among African Americans are undiagnosed.⁴ Although in 2007 a greater percentage of adult African Americans surveyed reported having been tested for HIV (52%) compared to Hispanics (38%) and whites (34%), 31% of adult African Americans have never been tested⁵ and over 70% report not being offered an HIV test by their health care provider.⁶

PS 07-768 HIV Testing Outcomes Among African Americans

PS 07-768 activities were monitored with data reported to CDC by grantees in aggregate through the Annual Progress Reports (APR) and at the individual test level through the National HIV Prevention Program Monitoring and Evaluation (NHM&E) reporting system. NHM&E data are a subset of all tests attributed to PS07-768 reported in APRs. NHM&E data reported here describe test level data attributed to PS07-768 submitted by grantees for all 3 years.

Number of PS07-768 Attributed HIV Testing Events and Newly Identified Confirmed Positives Among African Americans by Year

Overall HIV Testing and Positivity

• Over the 3-year period, of the 2,786,739 tests reported in aggregate in grantees' APRs, 1,411,780 tests (60%) were conducted among African Americans, of which 11,638 were newly identified confirmed positive (0.8%).
• Of the 2,011,540 testing events⁷ reported through the NHM&E system for PS07-768, 1,156,055 (57%) were among African Americans, of which 9,095 were newly identified confirmed positive (0.8%).
• Almost 65% of HIV testing events among African Americans occurred in health care settings, yielding a 0.7% newly identified confirmed positivity rate. The newly identified confirmed positivity rate in non-health care and other settings was 1.2% and 0.5%, respectively.

Percentages of HIV Testing Events, Confirmed New Positives and New Positivity Rates Among African Americans by Service Setting

HIV Testing by Gender Identity and Age

• Testing events were almost equally distributed between males (51%) and females (47%), with 0.1% of testing events attributed to transgender individuals. The newly identified confirmed HIV positivity rate was 1.0%, 0.5%, and 4.0%, for males, females, and transgender individuals, respectively.
• By age, the greatest proportion of testing events was conducted among 20-29 year olds (approximately 36%) followed by 30-39 year olds (approximately 19%), however the newly identified confirmed positivity rate was highest among 40-49 year olds (1.3%) and older adults aged ≥50 years of age (1.1%).

Percentages of HIV Testing Events, Confirmed New Positives and New Positivity Rates Among African Americans by Gender Identity

Percentages of HIV Testing Events, Confirmed New Positives and New Positivity Rates Among African Americans by Age Groups

HIV Testing by Behavioral Risk

• Among newly confirmed HIV-positive males for whom behavioral risk was collected, sexual contact with other males (MSM) (approximately 36%) was the highest reported risk behavior; while high-risk heterosexual contact (approximately 62%) was the highest reported risk behavior among newly confirmed HIV-positive females.

Percentage of Confirmed HIV Positive Events Among Male African Americans by Behavioral Risk

Percentage of Confirmed HIV Positive Events Among Female African Americans by Behavioral Risk

References and Notes

1. Centers for Disease Control and Prevention. HIV surveillance -- United States, 1981-2008. MMWR 2011; 60(21):689-93.
2. Humes K, Jones NA, Ramirez, RR. Overview of race and Hispanic origin: 2010. 2011. U.S. Census Bureau. Accessed February 1, 2012.
3. Prejean J, Song R, Hernandez A, Ziebell R, Green T, et al. 2011. Estimated HIV Incidence in the United States, 2006-2009. PLoS ONE 6(8): e17502. doi:10.1371/journal.pone.0017502.
4. Centers for Disease Control and Prevention. HIV prevalence estimates -- United States, 2006. MMWR 2008; 57(39): 1073-76.
5. Centers for Disease Control and Prevention. Persons tested for HIV -- United States, 2006. MMWR 2008; 57(31):845-49.
6. Black AIDS Institute. Passing the test: The challenges and opportunities of HIV testing in Black America. 2009. Accessed February 1, 2012.
7. A testing event is the sequence of one or more tests conducted on a person to determine his or her HIV status. During one testing event, a person may be tested once (e.g., one rapid test or one conventional test) or multiple times (e.g., one rapid test followed by one conventional test to confirm the preliminary HIV-positive test result).