Journal of Medical Screening > Volume 16, Number 2 > Pp. 60-66

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Original Articles

Demographic variations in HIV testing history among emergency department patients: implications for HIV screening in US emergency departments

Roland C MerchantMD, MPH, ScD, Assistant Professor of Emergency Medicine and Community Health  , Department of Emergency Medicine; Department of Community Health, Warren Alpert Medical School of Brown University, Providence, RI; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

Bethany M CatanzaroMPH, Research Assistant , Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA

George R Seage, IIIMPH, ScD, Associate Professor of Epidemiology , Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

Kenneth H MayerMD, Professor of Medicine , Department of Community Health, Warren Alpert Medical School of Brown University, Providence, RI; Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA

Melissa A ClarkPhD, Associate Professor of Community Health , Department of Community Health, Warren Alpert Medical School of Brown University, Providence, RI, USA

Victor G DeGruttolaScD, Professor of Biostatistics , Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

Bruce M BeckerMD, MPH, Professor of Emergency Medicine and Community Health , Department of Emergency Medicine; Department of Community Health, Warren Alpert Medical School of Brown University, Providence, RI, USA

Correspondence to: Roland C Merchant MD MPH ScD, Department of Emergency Medicine, Rhode Island Hospital, 593 Eddy Street, Claverick Building, Providence, RI 02903, USA; rmerchant{at}lifespan.org

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Objective To determine the proportion of emergency department (ED) patients who have been tested for human immunodeficiency virus (HIV) infection and assess if patient history of HIV testing varies according to patient demographic characteristics.

Design From July 2005–July 2006, a random sample of 18–55-year-old English-speaking patients being treated for sub-critical injury or illness at a northeastern US ED were interviewed on their history of HIV testing. Logistic regression models were created to compare patients by their history of being tested for HIV according to their demography. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated.

Results Of 2107 patients surveyed who were not known to be HIV-infected, the median age was 32 years; 54% were male, 71% were white, and 45% were single/never married; 49% had private health-care insurance and 45% had never been tested for HIV. Of the 946 never previously tested for HIV, 56.1% did not consider themselves at risk for HIV. In multivariable logistic regression analyses, those less likely to have been HIV tested were male (OR: 1.32 [1.37–2.73]), white (OR: 1.93 [1.37–2.73]), married (OR: 1.53 [1.12–2.08]), and had private health-care insurance (OR: 2.10 [1.69–2.61]). There was a U-shaped relationship between age and history of being tested for HIV; younger and older patients were less likely to have been tested. History of HIV testing and years of formal education were not related.

Conclusion Almost half of ED patients surveyed had never been tested for HIV. Certain demographic groups are being missed though HIV diagnostic testing and screening programmes in other settings. These groups could potentially be reached through universal screening.

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