ARE HIV-INFECTED INJECTION-DRUG USERS TAKING HIV TESTS

Objectives. Knowledge of infection is essential for human immunodefici ency virus-type 1 (HIV-1) treatment initiation and epidemic control. T his study evaluates infection knowledge among infected injection drug users and acceptance of confidential testing among injection drug user s, particularly those infected with HIV-1. Methods. A total of 810 inj ection drug users entering treatment in Contra Costa County, Calif, we re examined. Clients were tested with unlinked (blinded) tests and sim ultaneously counseled and offered voluntary confidential HIV-1 antibod y testing. Data on confidential testing acceptance, previous testing, drug use, and demographic information were collected. Results. Of the 810 tested, 105 (13.0%) were infected. The current confidential test w as accepted by 507 (62.6%). HIV seroprevalence in the unlinked survey was four times greater than in the voluntary survey (13% and 3.5%, res pectively). HIV-1 infection was associated with refusal of a confident ial test largely because most infected injection drug users (n = 58; 5 5.2%) already knew of their infection. Of the 47 injection drug users who were not aware of their infection, 12 (25.5%) accepted the test. A lthough African-American injection drug users presented with a higher infection rate (37.3%), they were three times less likely to know of t heir infection. Conclusions. ''In-clinic'' HIV-1 testing is highly acc epted, and most infected clients in treatment will learn their status. Nevertheless, voluntary testing data are likely to yield considerable underestimates of the true rate of infection among injection drug use rs.