title: Human immunodeficiency virus testing behaviors among US adults: the roles of individual factors, legislative status, and public health resources.
abstract: BACKGROUND
  The Centers for Disease Control and Prevention recommended an "opt-out" human immunodeficiency virus (HIV) testing strategy in 2006 for all persons aged 13 to 64 years at healthcare settings. We conducted this study to identify individual, health, and policy factors that may be associated with HIV testing in US adults.
  
  
  METHODS
  The 2008 Behavioral Risk Factors Surveillance System data were utilized. Individuals' residency states were classified into 4 categories based on the legislation status to HIV testing laws in 2007 and HIV/acquired immune deficiency syndrome morbidity. A multivariate logistic regression adjusting for survey designs was performed to examine factors associated with HIV testing.
  
  
  RESULTS
  A total of 281,826 adults aged 18 to 64 years answered HIV testing questions in 2008. The proportions of US adults who had ever been tested for HIV increased from 35.9% in 2006 to 39.9% in 2008. HIV testing varied across the individual's characteristics including sociodemographics, access to regular health care, and risk for HIV infection. Compared with residents of "high morbidity-opt out" states, those living in "high morbidity-opt in" states with legislative restrictions for HIV testing had a slightly lower odds of being tested for HIV (adjusted odds ratio = 0.96; 95% confidence interval = 0.92, 1.01). Adults living in "low morbidity" states were significantly less likely to be tested for HIV, regardless of legislative status.
  
  
  CONCLUSIONS
  To implement routine HIV testing in the general population, the role of public health resources should be emphasized and legislative barriers should be further reduced. Strategies need to be developed to reach people who do not have regular access to health care.
authors.affiliation: Department of Medicine, Penn State Hershey College of Medicine, Hershey, PA 17033-0855, USA. ping.du@psu.edu
authors.forename: Ping
authors.initials: P
authors.lastname: Du
authors.forename: Fabian
authors.initials: F
authors.lastname: Camacho
authors.forename: John
authors.initials: J
authors.lastname: Zurlo
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Lengerich
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D002487:Centers for Disease Control and Prevention, U.S. / Q000331:legislation & jurisprudence; D016001:Confidence Intervals; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000821:virology; D015438:Health Behavior; D006291:Health Policy / Q000331:legislation & jurisprudence; D006295:Health Resources; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011634:Public Health / Q000331:legislation & jurisprudence*; D014481:United States; D055815:Young Adult