TRENDS IN HIV SEROPOSITIVITY IN PUBLICLY FUNDED HIV COUNSELING AND TESTING PROGRAMS - IMPLICATIONS FOR PREVENTION POLICY

Introduction: We describe trends in seropositivity among clients atten ding publicly funded HIV counseling and testing sites across the Unite d States and discuss implications for prevention policy. Methods: The present analysis used client-level data from 1990 through 1994 for 26 of 65 state, territorial, and local health departments receiving Cente rs for Disease Control and Prevention funds. Logistic regression was u sed to predict the proportion of HIV tests that were positive, Curves were created representing adjusted HIV seropositivity trends for 1990 through 1994. Results: HIV seropositivity rates were higher before 199 2. Throughout, rates were higher among men, most racial/ethnic minorit ies tested, and persons 30 years or older. Although rates for men rema ined higher than those for women, the gap has narrowed in recent years . For both men and women, rates remained low for those reporting heter osexual activity as their only potential risk for HIV. Over time, more high-risk seronegatives are being repeatedly tested. Conclusions: Low er, stabilized seropositivity rates after 1992 reflect large increases in testing volume, increasing frequency of repeat testing, and fewer asymptomatic-infected persons entering this public system. Various pro gram innovations including enhanced outreach, improved access, rapid t esting, and client-centered counseling should be considered as strateg ies to increase the number of infected persons who learn their serosta tus early and enter into medical care.