HIV testing among at risk adolescent populations, how can we do better? YRBS, 2005-2011 Open Access

Abstract

Background: HIV testing is crucial among adolescents aged 13-19, as they often report multiple HIV risk behaviors. Currently, most are unaware of their positive HIV status (59.5% of HIV-positive people aged 13-24) and adolescents aged 13-19 account for 5% of new infections in the US. Purpose: The purpose of this study was to (i) assess the association between HIV testing and related risk behaviors, controlling for sex, grade, race and ethnicity, (ii) examine changes overtime in HIV testing and related risk behaviors at the national and state levels, and (iii) compare 2011 state and national levels of HIV testing and related risk behaviors. Methods: This study used the biennial state and national Youth Risk Behavioral Survey (YRBS), representative of students in 9th through 12th in the US for the period 2005-2011, and focused on sexually active students. Risk behaviors included in the study were condom use, number of sexual partners in lifetime, age at first intercourse, ever forced sexual intercourse, and ever illegal injection drug use. Assessment was performed through logistic regression and trend analyses. Results: HIV testing was associated with all analyzed risk behaviors among sexually active high school students, controlling for sex, grade, race and ethnicity. The national level of HIV testing among sexually active high school students was stable around 22% over the 2005-2011 period. In contrast to the national level, evolution of HIV testing and related risk behaviors was observed in some states. Additionally, meaningful differences in HIV testing and related risk behaviors were found across states in 2011. Conclusions: As of 2011, most sexually active high school students had never been tested for HIV, despite engaging in HIV-related risk behaviors. Although the situation has remained mostly unchanged between 2005 and 2011 at the national level, states display different evolutions and prevention needs. This calls for a more extensive use of YRBS to monitor progress in HIV prevention and testing among adolescents, and ultimately enhance early linkage of HIV positive adolescents to care.

Table of Contents

TABLE OF CONTENTS Introduction 1 Literature review 3 Materials and methods 10 Data source 10 Variables of interest 11 Descriptive analyses 13 Trend analysis 13 Logistic regression analysis 14 Results 15 Descriptive analysis at national level 15 National trends in HIV testing and related risk behaviors, 2005-2011 15 Association of HIV testing and related risk behaviors at national level 16 Descriptive analysis at state level 19 State trends in HIV testing and related risk behaviors, 2005-2011 21 Cross-state comparison of HIV testing in 2011 23 Discussion 24 Tables and figures 32 Table 1. Characteristics of high school students who had sexual intercourse, National YRBS, 2005-2011 32 Figure 1. Distribution of demographics for high school students who had sexual intercourse, National YRBS, 2005-2011 33 Figure 2. Trends in HIV testing and related risk behaviors for high school students who had sexual intercourse, National YRBS, 2005-2011 34 Table 2. Trends in HIV testing and related risk behaviors for high school students who had sexual intercourse , National YRBS, 2005-2011 34 Table 3. Unadjusted association of HIV testing with related risk behaviors controlling for demographics among high school students who had sexual intercourse, National YRBS, 2005-2011 35 Table 4. Interaction assessment of HIV-related risk behaviors with demographics and years by strata, National YRBS, 2005-2011 35 Table 5. Adjusted association of HIV testing with related risk behaviors controlling for demographics among high school students who had sexual intercourse, National YRBS, 2005-2011 36 Table 6. Availability of state level datasets collecting HIV testing information, YRBS, 2005-2011 36 Table 7. Characteristics of high school students who had sexual intercourse, State YRBS, 2005-2011 37 Figure 3. Characteristics of high school students who had sexual intercourse, National and State YRBS, 2005-2011 38 Table 8. Trends in HIV testing and related risk behaviors for high school students who had sexual intercourse , State YRBS, 2005-2011 39 Figure 4. Cross-state comparison of HIV testing among high school students who had sexual intercourse, National and State YRBS, 2011 41 Appendices 42 Appendix A: YRBS Questionnaire 42 Appendix B: Collinearity macro 42 Appendix C: SAS code 52 References 76

About this Master's Thesis

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School	Rollins School of Public Health
Department	Career Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	Adolescent epidemiology risk behavior HIV testing
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University Sullivan, Patrick S, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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