HIV Testing Among High-Risk Homeless Women--Good News from Los Angeles County

Herndon B, Kilbourne AM, Wang M, Lee M, Asch S, Andersen R, Gelberg L. HIV Testing Among High-Risk Homeless Women--Good News from Los Angeles County. Paper presented at: Society of General Internal Medicine Annual Meeting; 2000 May 1; Boston, MA.

PURPOSE: The potential for HIV testing to lead to improved health outcomes has never been greater, yet little is known about utilization of this service among populations at highest risk for HIV. The aim of this study is to determine the prevalence and predictors of HIV testing in a population of urban, poor, predominately minority homeless women in Los Angeles County.METHODS: Women were interviewed in shelters and meal programs in Los Angeles County to create a probability cluster sample (n = 974). Bivariate analysis of patient characteristics, contact with health and social services, and indications for HIV testing identified variables with p < 0.1, and these were entered into a multiple regression model. Additionally, stepping algorithms with random sub-sampling for cross-validation were used to develop a more parsimonious multiple regression model. Samples were weighted and cluster analysis was performed on final models.RESULTS: Approximately 70% of the sample reported receiving an HIV test in the past year. After adjustment for cluster effects, only a history of drug abuse or dependence and having a regular source or care were significant predictors of HIV testing in the past year. Sixty-five percent of respondents reported currently having a regular source of care. Neither income, public benefits, health insurance status, nor having a case manager predicted receipt of HIV testing. Similarly, none of the indications for HIV testing were statistically significant predictors. Of note, 15% of respondents reporting a pregnancy in the last year also reported that they did not receive an HIV test. There were no significant negative predictors of HIV testing in the past year.CONCLUSION: The rates of HIV testing in this probability sample of women are among the highest reported for any population studied and are consistent with prior research indicating that individuals at highest risk are more likely to be tested. However, there is a significant minority of at-risk women with specific indicationsfor testing, including pregnancy, who are not being reached. Our study indicates that policies focused on providing a regular source of care are likely to have the greatest impact on sertesting prevalence. However, the fact that our analyses revealed only two statistically significant predictors demonstrates that our current understanding of homeless women's use of this critical service is incomplete. Additional research is needed to better understand access to and utilization of HIV testing in this high-risk population.