HIV Testing Among Women Aged 18-44 Years
United States, 1991 and 1993
Human immunodeficiency virus (HIV) infection is a major cause
of morbidity and mortality among women and children in the United
States. In 1995, of the 73,380 acquired immunodeficiency syndrome
(AIDS) cases reported, women accounted for 13,764 (19%) (1). HIV
infection is the third leading cause of death among all U.S. women
aged 25-44 years and the leading cause of death among black women
in this age group (2). Moreover, an estimated 7000 infants are born
to HIV-infected women in the United States each year (3); without
intervention, approximately 15%-30% of these infants would be
infected (4). HIV counseling and testing services are important for
women to reduce their risk for becoming infected or, if already
infected, to initiate early treatment and prevent HIV transmission
to others, including their infants. This report summarizes findings
about HIV-testing practices for women aged 18-44 years based on
data obtained from CDC's 1991 and 1993 AIDS Knowledge and Attitudes
Supplements to the National Health Interview Survey (NHIS-AIDS),
which indicate that approximately one third of women aged 18-44
years have been tested for HIV.
The NHIS is an annual national probability sample of the
civilian household population of the United States. Data about HIV
testing have been collected annually as part of the NHIS-AIDS
Supplement since 1987. Information about a broad range of issues
related to HIV infection and AIDS was collected through personal
interview with one randomly selected adult (aged greater than or
equal to 18 years) per household. Response rates for the 1991 and
1993 NHIS-AIDS were 86% and 80%, respectively. Information about
voluntary HIV-testing practices was analyzed for women aged 18-44
years who responded to the survey; women who had HIV tests at the
time of blood donation were excluded. Because interviews for the
1993 NHIS-AIDS were conducted only for 6 months, the number of
responses from women in this age group is smaller (n=6267) than in
1991 (n=13,411). All data were analyzed using SUDAAN and weighted
to produce national estimates.
Although the 1993 NHIS-AIDS provides the most recent national
data available about HIV testing,* information about current or
past pregnancies was collected only during 1991. However, because
the number of pregnant women responding to the 1991 survey was too
small for meaningful estimates of HIV testing, 1991 data were
analyzed for the 30% of women (n=3996) who reported having had a
live-born infant during the preceding 5 years.
In 1991, 18.8% of women aged 18-44 years reported having been
tested for HIV antibody (Table 1). The proportion of black (25.7%)
and Hispanic (27.5%) women who reported having been tested was
substantially greater than that for white women (16.2%).** In
addition, women with less than 12 years of education were more
likely to report having ever been tested for HIV (25.1%) compared
with high school graduates (17.2%) or those who had completed
college (18.9%). A greater percentage of women living in poverty***
reported having been tested for HIV (25.9%) compared with those at
or above the poverty level (17.5%). Women who had been previously
married were more likely to report having been tested (24.0%) than
were those who were currently (18.4%) or never (17.4%) married.
Nearly 40% of women who perceived a high or medium risk for
becoming or being HIV-infected and 33.1% of those who reported any
HIV risk behavior had been tested.**** Compared with women residing
in non-metropolitan statistical areas (MSAs), women residing in
central cities of MSAs were more likely to have been tested (18.1%
and 20.5%, respectively); regionally, the highest rates of testing
were for women residing in the South (20.6%) and West (22.2%).
From 1991 to 1993, the proportion of women aged 18-44 years
who had ever been tested for HIV increased 60% (from 18.8% to
31.8%) (Table 1). Increases were similar across all
sociodemographic groups. As in 1991, in the 1993 survey, higher
percentages of black and Hispanic women (46.1% and 39.7%,
respectively) compared with white women (27.9%) reported having
been tested for HIV. Similarly, a higher proportion of women with
less than 12 years of education reported having been tested for HIV
(36.9%) compared with high school graduates (31.5%) or those with
college education (30.4%). In addition, more women living in
poverty reported having been tested for HIV (40.2%) than did women
living at or above the poverty level (30.3%). HIV-testing trends
among women aged 18-44 years were similar to those in 1991 with
respect to marital status, risk perception, and region of
residence; however, the proportions of women tested in all three
groups increased during 1991-1993 (Table 1). During 1991-1993, the
proportion of women tested who had higher perceived risk for HIV
did not increase; however, the proportion tested with low or no
perceived risk nearly doubled.
Women Who Had a Live-Born Infant During the Preceding 5 Years
In 1991, a higher proportion of women who reported having had
a live-born infant during the preceding 5 years had been tested for
HIV (25.7%) compared with all women aged 18-44 years (18.8%) (Table
1). Among women who reported a high or medium risk for becoming or
being infected, percentages were similar for those who had had a
live-born infant during the preceding 5 years (41.0%) and all women
(39.6%). Among women who reported having had a live-born infant
during the preceding 5 years, testing rates were highest among
Hispanics (35.0%) and blacks (33.4%), women with less than 12 years
of education (34.0%), and those living in poverty (36.2%).
Approximately twice as many never-married women who reported having
had a live-born infant during the preceding 5 years had been tested
for HIV (32.5%), compared with all never-married women in this age
Reported by: Div of Health Interview Statistics, National Center
for Health Statistics, CDC.
Editorial Note: The findings in this report indicate that the
proportion of women aged 18-44 years in the United States who
reported being tested for HIV infection increased in the early
1990s. This trend may reflect increased knowledge and awareness
about HIV and AIDS among women. However, the data in this report
probably underestimate current rates of HIV testing in pregnant
women because they do not reflect recent changes in testing
practices and because testing among women who had a live-born
infant during the preceding 5 years is not a good proxy for recent
pregnancy. During the period of the surveys, prenatal HIV testing
was targeted toward women known to be at increased risk for HIV
infection (5). Since then, studies have indicated that such testing
strategies failed to identify and offer services to many
HIV-infected women (6,7). In 1995, based on these findings and
advances in prevention and treatment for HIV infection, including
zidovudine therapy to reduce perinatal HIV transmission, the Public
Health Service issued recommendations for universal HIV counseling
and voluntary testing for pregnant women (4).
The higher rates of testing among poor, less educated minority
women may reflect trends in related factors, such as the use of
sexually transmitted disease and family-planning clinics as a
primary source of health care. In the survey, clinics were a
primary site of HIV testing for lower-income minority women. The
higher rates of testing among black and Hispanic women also reflect
trends in the incidence of AIDS cases in the United States. In
particular, the incidence of AIDS among women and minorities has
not declined as it has among white males (8). Poor access to
medical care, high rates of sexually transmitted diseases, and
other sociodemographic characteristics continue to be associated
with increased risk for infection among minority women. Reducing
the risk for HIV infection and AIDS will require culturally
appropriate HIV-prevention interventions that address the
particular concerns of black and Hispanic women (9,10).
Congress recently passed legislation stating that HIV
counseling and voluntary testing should be the standard of care for
all pregnant women in the United States*****. Surveys such as the
NHIS-AIDS and other studies will provide important data to help
public health and other health-care professionals evaluate the
extent of implementation of this prevention measure and its impact
on reducing HIV-related morbidity and mortality among women and
- CDC. HIV/AIDS surveillance report, 1995. Atlanta: US Department
of Health and Human Services, Public Health Service, 1996. (Vol 7,
- CDC. Update: mortality attributable to HIV infection among
persons aged 25-44 years--United States, 1994. MMWR 1996;45:121-5.
- Davis SF, Byers RH, Lindegren ML, Caldwell MB, Karon JM, Gwinn
M. Prevalence and incidence of vertically acquired HIV infection in
the United States. JAMA 1995;274:952-5.
- CDC. U.S. Public Health Service recommendations for human
immunodeficiency virus counseling and voluntary testing for
pregnant women. MMWR 1995;44(no. RR-7).
- CDC. Recommendations for assisting in the prevention of the
perinatal transmission of human T-lymphotropic virus type
III/lymphadenopathy-associated virus and acquired immunodeficiency
syndrome. MMWR 1985;34:721-32.
- Barbacci MB, Dalabetta GA, Repke JT, et al. Human
immunodeficiency virus infection in women attending an inner-city
prenatal clinic: ineffectiveness of targeted screening. Sex Transm
- Fehrs LJ, Hill D, Kerndt PR, Rose TP, Henneman C. Targeted HIV
screening at a Los Angeles prenatal/family planning health center.
Am J Public Health 1991;81:619-22.
- Rosenberg PS. Scope of the AIDS epidemic in the United States.
- Sikkema KJ, Koob JJ, Cargill VC, et al. Levels and predictors of
HIV risk behavior among women in low-income public housing
developments. Public Health Rep 1995;110:707-13.
- O'Donnell L, San Doval A, Vornfett R, O'Donnell CR. STD
prevention and the challenge of gender and cultural diversity:
knowledge, attitudes, and risk behaviors among black and Hispanic
inner-city STD clinic patients. Sex Transm Dis 1994;21:137-48.
* Data about HIV testing and other AIDS-related knowledge and
attitudes were collected in 1994 and 1995; however these data are
not yet available for analysis.
** Numbers for other racial groups were too small for meaningful
*** Poverty statistics are based on a definition originated by the
Social Security Administration in 1964, that was subsequently
modified by federal interagency committees in 1969 and 1980, and
prescribed by the Office of Management and Budget as the standard
to be used by federal agencies for statistical purposes.
**** Respondents were asked whether they 1) had hemophilia or other
clotting disorder and had received clotting concentrations since
1977; 2) had injected illegal drugs at any time since 1977; 3) had
exchanged sex for money or drugs since 1977; and 4) had been the
sex partner since 1977 of someone to whom any of these conditions
***** Public Law 101-545.