Predictors of HIV Testing Rates and Locations Among Asian and Pacific Islanders in the United States

Background and Purpose: Asian/Pacific Islanders (APIs) are the fastest growing racial/ethnic group in the United States (U.S.), with a 46% growth rate seen between 2000 and 2010. Disturbingly, surveillance data has revealed HIV-positive diagnoses are growing faster among APIs in the country than any other racial/ethnic group; with other racial/ethnic groups actually seeing a decline in their rates. HIV testing is an essential and critical step towards detecting, treating, and preventing viral transmission, however research has been limited in detailing the factors that may influence HIV testing patterns for this population. In order to understand where preventative efforts need to further be implemented, the sociodemographic and socioeconomic factors associated with HIV testing rates and most frequently accessed testing sites among APIs in the United States are discussed.

Methods: HIV testing rates and location type for APIs were examined using data collected for the 2015 CDC-funded Behavioral Risk Factor Surveillance System (BRFSS) survey. Logistic regression analysis was used to predict the rates of HIV testing with the simultaneous entry of three sociodemographic predictors (age, gender, and marital status) and three socioeconomic predictors (education level, employment status, and income level). Exploratory analysis was then used to examine the distribution of HIV testing locations to determine which sites were most often frequented.

Results: Among 13795 respondents who identified as Asian/Pacific Islander, 3173 participants reported they had been tested for HIV at least once in their lifetime. Results of the logistic regression analysis indicated all sociodemographic and socioeconomic variables entered into the model were significant predictors of HIV testing when each respective variable was held constant. Age, gender identity, employment status, and income level were the strongest associated predictors of HIV testing among APIs.  Results revealed the odds of testing for HIV was greater for individuals who were ages 35 to 44, female, previously married, college or technical school graduates, employed, or earned an annual income of $75,000 or more. Among those who accessed HIV testing services, participants reported they were most likely to get tested for HIV at their private medical doctor’s office (42.7%) or HMO clinic (25.1%).

Conclusions and Implications: To date, this study is the largest report of nationwide data examining how age, gender, marital status, education level, employment status, and income level are associated with API testing rates as well as the distribution of testing sites frequented by this population. We found significant relationships among each variable that further inform how HIV/AIDS prevention efforts should be implemented with APIs residing in the US. The findings of this study reveal novel insights and contradict the findings of studies with smaller sample sizes of APIs. These results hold relevance in recognizing the differences of which clusters of APIs are more likely to access HIV testing in order to provide greater outreach for those who are less likely to test for HIV. To close the health gap, preventative-testing services must continue to be promoted among APIs to prevent the HIV epidemic from reaching this fast-growing population.