Counseling and testing are important components of state and local
HIV prevention programs . Analysis of national data sources
indicates that HIV antibody tests are obtained from a variety
of testing sites, including private physicians, hospitals, and
outpatient clinics (66.7%), and publicly funded sites (33.1%)
. This report uses data from CDC's 1993 Behavioral Risk Factor
Surveillance System (BRFSS) to examine variations in rates of
use of private and public HIV counseling and testing sites by
In 1993, a total of 49 states and the District of Columbia participated
in the BRFSS, a state-specific, population-based, random-digit-dialed
telephone survey that collects information monthly from U.S. adults
aged 18 years or older. Thirteen questions about HIV/AIDS-related
knowledge and attitudes, and HIV antibody testing history during
the preceding year were asked only of respondents aged 65 years
or younger. In 1993, a total of 84,039 persons responded to these
questions (state-specific range: 993 to 3,367) . Data for each
state were weighted by demographic characteristics and by selection
probability; results are representative of persons aged 18 to
65 years in each state.
A median of 25.5% of persons (range: 14.4% [Iowa] to 37.5% [Alaska])
answered yes to the question: "Except for donating or giving
blood, have you ever had your blood tested for the AIDS virus
infection?" The number (weighted estimate) of adults who
had ever been tested for HIV was highest in California (6.3 million).
A median of 9.6% of persons (range: 4.1% [Maine and South Dakota]
to 16.9% [District of Columbia]) reported obtaining HIV antibody
tests primarily for diagnostic reasons. For this study, diagnostic
HIV antibody tests were defined as those administered primarily
to learn infection status, rather than voluntary tests to qualify
for insurance, military induction, immigration, marriage license
application, or employment. Persons categorized as having obtained
diagnostic HIV antibody tests were identified by one of three
responses to the question "What was the main reason you had
your last AIDS blood test?":
1. "To find out if infected"
2. "Because of referral by a doctor or health department
or sex partner"
3. "For routine checkup." This response was included
in "diagnostic" reasons to avoid excluding respondents
who initiated a routine examination to determine whether they
were infected with HIV.
In 43 states and the District of Columbia, at least 50% (median:
60.9%) of respondents had obtained their last diagnostic test
from a private physician, health maintenance organization, or
private outpatient clinic. A median of 16.2% of persons (range:
5.0% [North Dakota] to 37.6% [Mississippi]) had obtained their
last diagnostic test at a publicly funded prevention site (including
health departments; AIDS, sexually transmitted disease [STD],
or tuberculosis clinics; and drug treatment programs).
The estimated number of persons who obtained a diagnostic test
at a publicly funded site during the preceding year correlated
with the number of tests reported to CDC's HIV Counseling and
Testing System by publicly funded sites in each state .
A median of 60.7% of persons who had obtained their most recent
diagnostic HIV antibody test at a publicly funded site (range:
30.8% [New Jersey] to 95.7% [Oklahoma]) received counseling with
their test results. In comparison, a median of 28.2% of persons
who had obtained their tests from a private site (range: 7.7%
[Kentucky] to 77.3% [Oklahoma]) received counseling. In 90% of
the reporting areas, the number of persons who received counseling
with their HIV test results was at least 1.5 times greater for
persons tested at publicly funded sites than those tested at private
Editorial Note from the CDC: The findings from the 1993
BRFSS document a high degree of state-specific variability in
self-reported HIV antibody tests in the United States. This variability
may reflect state-specific differences in such factors as the
prevalence of HIV infection, and HIV testing in high-risk groups,
the presence and impact of HIV prevention programs, and age distribution.
The BRFSS estimates of the number of persons last tested for voluntary
or diagnostic reasons at a publicly funded clinic correlated highly
with estimates from CDC's HIV Counseling and Testing System, and
the median percentage of respondents ever tested for HIV (25%)
is consistent with estimates based on CDC's National Health Interview
Health-care visits to seek and obtain HIV tests are important
opportunities to counsel persons about the risk for HIV infection
and methods to reduce such risk.1 The data in this report indicate
that, in most states, approximately threefold more persons reported
having obtained their HIV test from a private provider than from
a public site; however, persons who had obtained their test from
a private provider were substantially less likely to have reported
receiving counseling than those who obtained tests at a public
site. This finding underscores the need for physicians and other
health-care providers in private settings to offer HIV counseling
at the time patients receive their HIV test results.
The findings in this report are subject to at least two limitations.
First, the sample size of persons who reported having had an HIV
antibody test in individual states did not enable stratification
by other respondent characteristics. For example, state-specific
sample sizes precluded analysis to determine whether specific
high-risk populations that obtained HIV antibody testing also
Second, because the BRFSS is a telephone-based system, some persons
at high risk for HIV infection most likely were excluded from
The BRFSS is a unique source for information about HIV antibody
testing behaviors of U.S. adults--particularly patterns of HIV
testing outside of public clinics--and can be used both at the
federal and state levels to improve HIV prevention and intervention
programs. Questions about CT in the 1993 BRFSS were developed
based on input from state health departments; subsequent BRFSS
surveys may incorporate additional HIV-related behavioral questions.
1. Hinman AR: Strategies to prevent HIV infection in the United
States. Am J Publ Health 81:1557-1559, 1991.
2. CDC: HIV counseling and testing services from public and private
providers-United States, 1990. MMWR 41:743,749-752, 1992.
3. CDC: 1993 BRFSS quality control report. Atlanta, US Department
of Health and Human Services, Public Health Service, CDC, 1994.
4. CDC: HIV counseling and testing data system: National profile,
1993. Atlanta, US Department of Health and Human Services, Public
Health Service, CDC, 1994.