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revealed that whereas 22% reported some risk of HIV infection, of those, only 24% had been tested for HIV [20]. Among attendees of US clinics for the treatment of sexually transmitted diseases, African-Americans have been reported to be more likely to refuse HIV testing, to report not having been tested in the past and to fail to return for their test results if they are tested [21, 22, 23, 24, 25], when compared with white clients. Test refusal and failure to return for results have been associated with a number of factors, including previous testing episodes, fear of learning positive results, and perceptions of low risk [21, 22]. In a study of 952 clients voluntarily entering public alcohol treatment centers in San Francisco, African-American and Hispanic clients were significantly less likely to report previous HIV testing, when compared with whites [26]. Taken in aggregate, these data suggest that whereas some racial/ethnic minority populations report more frequent testing than whites, there is also evidence that a substantial number of at-risk racial/ethnic minorities have not yet been tested for HIV, or test late, after the presentation of symptoms.
Summary
Further understanding of the impact that demographic and social factors have on time from HIV infection to diagnosis is important to people living with HIV and their families. As well findings of this area will inform research on the social determinants of HIV/AIDS and disease progression. It is anticipated that future research to examine the relationship between social factors, and health and well-being among people living with HIV will be of benefit to them. 1.
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Income
Several studies have shown inverse associations of HIV testing with income in the United States, i.e. people of lower income are more likely to have been tested for HIV [17, 18, 27]. However, the association between higher income and educational levels and earlier HIV diagnosis (i.e. recognition of seropositivity 5 years before the diagnosis of AIDS) has also been reported [11].
Men who have sex with men
Although it has been reported that gay men with high, self-reported sexual risk are more likely to be repeatedly tested for HIV (28, 29), other people from this population may be unaware of their serostatus. Studies from the United States and Canada, based on both community and household venues, showed that between 32% and 47% of gay men sampled did not know their current HIV serostatus [30, 31]. Among gay and bisexual men at risk of HIV infection, the fear of learning about a positive test is a commonly reported reason for delaying or avoiding HIV testing [30, 31, 32, 33]. Also, reasons for not testing include a previous bad testing experience, concerns about confidentiality/ desire for anonymity, and perceptions of being in good health and therefore not requiring the test [30, 31, 32, 33, 34]. Particularly interesting is the finding that gay men who have higher levels of socialization in gay identified venues [35], and those who are better integrated into the gay community [36] are more likely to be tested for HIV.
Injection drug users (IDU)
Among injection drug users in the United States and the United Kingdom, drug treatment is a major predictor of HIV antibody testing [37, 38, 39]. A history of incarceration or treatment for a sexually transmitted disease also predicts HIV testing among IDU [37]. The presence of symptomatic HIV disease has been reported to be strongly associated with HIV testing among IDU [37]. In a review of over 72,000 testing episodes in the United States publicly funded sites, the highest rate of HIV infection among IDU was found among those clients being seen in physician office sites, perhaps reflecting people who were seeking care for symptomatic HIV disease [40].
medical students worldwide
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