HIV Testing Among United States High School Students at the State and National Level, Youth Risk Behavior Survey 2005-2011

Background: Human immunodeficiency virus (HIV) remains an important public health issue and CDC recommends routine HIV screening for Americans aged 13-64. Adolescents and young adults are disproportionately affected compared to the overall population. We analyzed self-reported HIV testing and related risk behaviors at the state and national level among youths who had sexual intercourse, with a focus on state level differences.

Methods: This study used the state and national Youth Risk Behaviors Surveys 2005-2011. It included a total of 59,793 national-level observations and 39,421 state-level observations of US high school students, of which respectively 28,177 and 13,916 reported ever having sexual intercourse. The outcome of interest was having ever been tested for HIV. The risk behaviors were condom use at last intercourse, number of sexual partners in lifetime, age at first intercourse, ever forced sexual intercourse, and ever illegal injection drug use. Analyses performed included logistic regression and t-test analyses.

Results: HIV testing was positively associated with HIV-related risk behaviors among sexually active high school students. However, HIV testing remained relatively low (22%) between 2005 and 2011, even for those engaging in risk behaviors. Results differed among the only 7 states that monitored HIV testing through YRBS, most commonly with respect to HIV testing and condom use.

Conclusions: Routine HIV testing is critical for early identification of HIV, which was set as a priority in a recent Executive Order. Our data suggest further efforts are needed to achieve widespread uptake of HIV testing among high school students. Furthermore, differences observed across states likely reflect different needs and should be followed up closely by states. Finally, having accurate data that reflects the reality of youths' lives is crucial for efficient prevention planning. Thus, more states should consider collecting HIV testing data to evaluate uptake of HIV testing among youth.