Questions for Isaedmarie Febo-Vazquez, M.S., Epidemiologist and Lead Author of “Main Reasons for Never Testing for HIV Among Women and Men Aged 15–44 in the United States, 2011–2015”
Q: What made you decide to focus on the reasons Americans aren’t getting HIV tests for the subject of your new report?
IFV: Our main motivation for conducting this study was our curiosity about why a large number of women and men aged 15-44 have never been tested for HIV. The 2011-2015 National Survey of Family Growth, or NSFG, provides nationally representative data on HIV testing among women and men aged 15-44. Despite the considerable evidence of the benefits of early detection of HIV and initiatives to promote routine HIV testing, there is a significant proportion of adults aged 15-44 in the United States that have never been tested for HIV. Our NSFG data on the reasons why people haven’t been tested for HIV recently became available, and we were curious to investigate these reasons.
Q: Was there a result in your study that you hadn’t expected and that really surprised you?
IFV: The survey question which asks what is the main reason for never testing for HIV is a relatively new question in the NSFG — since 2011. And this is the first time we’ve analyzed this important data. Some interesting findings include differences in the reasons Americans have never tested for HIV — by level of education. For example, a higher percentage of men and women aged 22-44 with Bachelor’s degrees or more education said that the main reason they had never been tested for HIV was because they were unlikely to have been exposed to HIV — compared with those who had less than a high school diploma. We were expecting to see some variations by level of education but were not sure which group would present a higher percentage for this reason for never being tested.
Q: What differences or similarities did you see among race and ethnic groups, and various demographics, in this analysis?
IFV: There are a number of interesting demographic findings in this report. Non-Hispanic Black men and women aged 15-44 were less likely to have never been tested for HIV, compared to other race and ethnic groups. A higher proportion of non-Hispanic white women and men said the main reason they had never been tested for HIV was because they were unlikely to have been exposed to HIV. In contrast, Hispanic men and women were most likely to report they were never offered an HIV test compared with other race and ethnic groups.
Q: What sort of trend data do you have on this topic so we can see how attitudes and behaviors have evolved over time?
IFV: This is the first time we have published data on the main reasons for never testing for HIV. There are prior published reports about HIV testing using NSFG data, but we did not focus on comparing data over time in this report. Instead, we provide additional information related to HIV testing that could help guide national prevention strategies.
Q: How is the data in this report different or the same when compared to the other National Center for Health Statistics surveys that measure HIV testing, like the National Health Interview Survey and the National Health and Nutrition Examination Survey?
IFV: The data on HIV testing that comes from different surveys at our agency offers a comprehensive picture of this important public health measure. The overall HIV-testing-question series in the NSFG is patterned after the National Health Interview Survey, or NHIS, and other surveys, where generally a distinction is made between testing done passively as part of donating blood or blood products and all other contexts for HIV testing. The NHIS currently collects data on ever having an HIV test outside of a blood donation, while the NSFG collects data on HIV testing as both part of blood donation and outside of blood donation. Also, the response categories for the question on the main reason for never having been tested for HIV are not the same for NHIS and NSFG.
Q: What is the take-home message of this report?
IFV: I think the take-home message of this report is that despite the considerable evidence of the benefits of early detection of HIV and initiatives to promote routine HIV testing, there is a significant proportion of adults aged 15-44 in the United States that have never been tested for HIV. Overall, 38.8% of women and more than half of men aged 15-44 have never tested for HIV outside of donating blood or blood products. The most common reason reported by women and men for never testing for HIV was that they were “unlikely to have been exposed to HIV,” followed by they had “never been offered an HIV test.” The NSFG continues to provide valuable nationally representative information to help evaluate and guide national HIV prevention strategies.