title: Which adults in the Paris metropolitan area have never been tested for HIV? A 2010 multilevel, cross-sectional, population-based study.
abstract: BACKGROUND
  Despite the widespread offer of free HIV testing in France, the proportion of people who have never been tested remains high. The objective of this study was to identify, in men and women separately, the various factors independently associated with no lifetime HIV testing.
  
  
  METHODS
  We used multilevel logistic regression models on data from the SIRS cohort, which included 3006 French-speaking adults as a representative sample of the adult population in the Paris metropolitan area in 2010. The lifetime absence of any HIV testing was studied in relation to individual demographic and socioeconomic factors, psychosocial characteristics, sexual biographies, HIV prevention behaviors, attitudes towards people living with HIV/AIDS (PLWHA), and certain neighborhood characteristics.
  
  
  RESULTS
  In 2010, in the Paris area, men were less likely to have been tested for HIV at least once during their lifetime than women. In multivariate analysis, in both sexes, never having been tested was significantly associated with an age younger or older than the middle-age group (30-44 years), a low education level, a low self-perception of HIV risk, not knowing any PLWHA, a low lifetime number of couple relationships, and the absence of any history of STIs. In women, other associated factors were not having a child < 20 years of age, not having additional health insurance, having had no or only one sexual partner in the previous 5 years, living in a cohabiting couple or having no relationship at the time of the survey, and a feeling of belonging to a community. Men with specific health insurance for low-income individuals were less likely to have never been tested, and those with a high stigma score towards PLWHA were more likely to be never-testers. Our study also found neighborhood differences in the likelihood of men never having been tested, which was, at least partially, explained by the neighborhood proportion of immigrants. In contrast, in women, no contextual variable was significantly associated with never-testing for HIV after adjustment for individual characteristics.
  
  
  CONCLUSIONS
  Studies such as this one can help target people who have never been tested in the context of recommendations for universal HIV screening in primary care.
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France. veronique.massari@iplesp.upmc.fr.
authors.forename: Véronique
authors.initials: V
authors.lastname: Massari
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France. annabelle.lapostolle@iplesp.upmc.fr.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Lapostolle
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France. marie-catherine.grupposo@iplesp.upmc.fr.
authors.forename: Marie-Catherine
authors.initials: MC
authors.lastname: Grupposo
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France. rosemary.dray-spira@iplesp.upmc.fr.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Dray-Spira
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of HIV Clinical Research, F-75013, Paris, France. dominique.costagliola@iplesp.upmc.fr.
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis Institute d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F-75012, Paris, France. pierre.chauvin@iplesp.upmc.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Chauvin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D005602:France; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D055361:Multilevel Analysis; D010297:Paris; D012649:Self Concept; D012725:Sexual Behavior; D012923:Social Class; D055815:Young Adult