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
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