HIV test locations and information received by MSM and heterosexual men and women American Public Health Association Annual Meeting November 5, 2007 Washington, D.C. Mary Milnamow, BA and Jennifer Lauby, Ph.D. Philadelphia Health Management Corp. Factors Associated with Counseling and Testing [FACT] Study

Background for FACT study Factors Associated with Counseling & Testing PHMC received funding from NIMH to conduct a three-year study of the barriers and predictors to HIV testing (2001-2003) Two population groups were the focus: PHASE 1: Men who have sex with men (MSM) Men were eligible to participate if they were 18 years or older; lived in the 9-county Philadelphia Metropolitan area; and had sexual contact with another man in the past 5 years

PHASE 2: High-risk heterosexual men and women Men and women were eligible to participate if they were 18 years or older; lived in the 9-county Philadelphia metropolitan area; and reported one or more of the following: ever injected drugs with a needle; ever had sex with someone who was an IV drug user or who tested positive for HIV; had sex with two or more people in the past 12 months

Data collection PHASE 1 PHASE 2 451 interviews were completed with MSM between June 2001 and January 2002 with the assistance of Safeguards, a local community-based organization Men were recruited in 65 locations throughout Philadelphia PHASE 2 1281 interviews were completed with heterosexual men and women from the community between December 2001 and January 2003 The men and women were recruited from randomly chosen locations in the 10 zip codes throughout Philadelphia with the highest HIV rates

Objective Examine types of places where MSM and high-risk heterosexual men and women received their most recent HIV test and the information received as part of their test This analysis is limited to men and women who reported taking an HIV test in the past two years at the time of survey administration and excluded anyone who reported being HIV positive 265 MSM 564 High-risk heterosexual men and women 389 men (69%) 175 women (31%)

Socio-demographic characteristics of MSM and heterosexual samples Race (n=265) 22% Black 43% White 35% Latino & Other Age (n=263) 27% 18-24 years old 52% 25-39 years old 20% 40 + years old Heterosexual men & women Race (n=563) 74% men & 80% women Black 5% men & 6% women White 20% men & 14% women Latino & Other Age* (n=564) 22% men & 26% women 18-24 yrs 32% men & 47% women 25-39 yrs 46% men & 27% women 40+ yrs * Heterosexual men were significantly more likely to be older than women (p<.001).

Socio-demographic characteristics of MSM and heterosexual samples Education (n=264) 11% <H.S. 26% H.S./GED 26% Some college 37% College + Personal Annual Income (n=259) 36% <$20,000 37% $20,000-$39,999 27% $40,000+ Heterosexual men & women Education (n=561) 28% men & 37% women <H.S. 55% men & 49% women H.S./GED 14% men & 11% women Some college 3% men & 2% women College + Personal Annual Income (n=564) 67% men & 73% women <$20,000 22% men & 21% women $20,000-$39,999 11% men & 6% women $40,000+

Health insurance status for MSM and heterosexual samples Heterosexual women were significantly more likely to be insured than heterosexual men (77% vs. 63%, p<.01). Over half the MSM sample had private insurance compared to only 16% & 15% of the heterosexual sample.

HIV testing behaviors MSM Sample 66% of the entire sample reported taking an HIV test in the past 2 years (n=292) Mean number of HIV tests ever taken for: MSM 6.96 (n=265) Heterosexual Sample 62% of women reported taking an HIV test in the past 2 years (n=241) compared to 55% of men (n=486) Mean number of HIV tests ever taken for: Women 4.89 (n=175) Men 5.16 (n=389) Only a quarter of heterosexual men and women reported taking 6 or more HIV tests in their lifetime compared to 42% of MSM.

Most recent HIV test locations for MSM and heterosexual samples *High-risk settings include jails, shelters and D&A treatment programs

Information received at most recent HIV test by MSM and heterosexual samples Heterosexual men were significantly less likely to receive an explanation of their results than women (70% vs. 79%, p<.05). MSM were less likely to receive testing and prevention information than heterosexual men & women.

Information received at most recent HIV test by MSM by test location (n=264) There was a significant difference for explaining results (p<.05); when to test again (p<.01); and HIV prevention info (p<.01) depending on where MSM took their most recent HIV test.

Information received at most recent HIV test by heterosexual men by test location (n=389) *There was a significant difference for explaining results of HIV test and receiving prevention information depending on where heterosexual men took their most recent HIV test (p<.05).

Information received at most recent HIV test by heterosexual women by test location (n=175)

Conclusions Over a third of the MSM sample tested at HIV organizations (35%) and 28% tested with their private doctors Very few heterosexual men and women tested at HIV organizations (9% & 6%) Heterosexual men were almost twice as likely as women to test in high-risk settings (32% vs. 17%, p<.001) Almost a third of heterosexual women tested at Family planning centers (30%)

Conclusions In our sample of MSM, private doctors were significantly less likely to provide testing and prevention information to men, suggesting private doctors were not taking advantage of the opportunity to deliver HIV information during the test. HIV organizations and STD clinics delivered testing and prevention information to the largest group of MSM. Women received testing and prevention information regardless of the location of their most recent HIV test. For heterosexual men, receiving an explanation of test results and HIV prevention information depended on their location. Only 60% of men who tested in high-risk settings were given an explanation of their results compared to all other locations (p<.01). Once again, HIV organizations provided prevention information to the most men (p<.05).