HIV Testing Among Sexually Experienced Teens, 1995-2002

PUTTING
WHAT WORKS TOw rk
A PROJECT OF THE NATIONAL CAMPAIGN TO PREVENT TEEN PREGNANCY
SCIENCE
THE NATIONAL CAMPAIGN TO PREVENT TEEN PREGNANCY
www.teenpregnancy.org ¦ 202.478.8500 ¦ web@teenpregnancy.org
Number 18 October 2005
Highlights:
¦ Only about one in three sexually
experienced5 teens (aged 15-19*)
have ever been tested for HIV.
¦ Sexually experienced teen girls
are more likely than teen boys to
have ever been tested.
¦ Among sexually experienced
teens, non-Hispanic Blacks are
more likely to have been tested
for HIV than Hispanics and
non-Hispanic Whites.
¦ The majority of sexually experienced
teens that have been tested
had their most recent HIV test at
a doctor’s office/HMO or clinic.6
¦ The primary reason that sexually
experienced teens get tested for
HIV is to find out if they are
infected, although more than one
in four girls who have been tested
for HIV reported that they
were tested because they were
pregnant or such testing was
offered as part of prenatal care.
* Readers should note that throughout this research brief, the word teen(s) refers to those aged 15-19 unless otherwise noted.
HIV Testing Among Sexually
Experienced Teens, 1995-2002
Says:
Approximately one in four of all new HIV infections occur in people under the age of 211 and the Centers for Disease
Control and Prevention (CDC) estimates that 13,752 young people aged 13-24 were living with HIV/AIDS in 2003.
Through 2003, more than 10,000 of those aged 13-25 had died as a result of AIDS infection.2
Despite the fact that most teens say AIDS is a serious problem for people their age, many sexually experienced young people have
not been tested for HIV and do not know if they are infected.3 Because sexually experienced teens are at risk of HIV infection, it
is important to know which teens get tested for HIV, where teens go for an HIV test, and why they decide to get tested. This
Science Says issue brief uses data from the National Survey of Family Growth (NSFG) to explore HIV testing among sexually
experienced teens. A second Science Says issue brief (#19) explores the extent to which sexually experienced teens receive counseling
following an HIV test.
Some may wonder why an organization whose mission is to prevent teen pregnancy is examining data on HIV/AIDS and STDs.
First and foremost, the more that is known about the sexual attitudes and behavior of teens, the better the nation can help young
people avoid risky sexual behavior. It is also true that a growing proportion of newly diagnosed HIV cases can be attributed to
heterosexual transmission through vaginal intercourse4, and teens who have unprotected sex are at risk for both STD/HIV infection
and pregnancy. When teens have an HIV test—one that they have requested or for which they have been referred—health
care providers have an opportunity and an obligation to discuss the risks of unprotected sex including both pregnancy and the
spread of HIV/STDs. And, of course, HIV testing and education are also important for those teens who do become pregnant.
All of the data in this Science Says are from the 2002 NSFG unless otherwise indicated. For this survey, sexually experienced
teens who received an HIV test were asked why they had the HIV test. They selected all of the answer choices that applied from
the following list: "For hospitalization or surgical procedure", "To apply for health or life insurance", "Just to find out if you were
infected", "Because of a referral by a doctor", "To apply for a marriage license", "Because you were pregnant or because it was
part of prenatal care", and "Some other reason". Although this list helps us understand more about reasons for testing, we recognize
that some ambiguities remain.
Sexually experienced teen
girls are more likely to have
been tested for HIV than sexually
experienced teen boys.
¦ Among sexually experienced
teens, girls are significantly7 more
likely to have had an HIV test
(41%) than boys (24%) (Figure
1).
¦ This pattern is also true for
younger (aged 15-17) and older
(aged 18-19) teens. Almost four
in ten (38%) sexually experienced
girls aged 15-17 have had
an HIV test, while only one in
four (25%) sexually experienced
younger teen boys have had an
HIV test. Among older sexually
experienced teens (aged 18-19),
girls (43%) are almost twice as
likely as boys (24%) to have had
an HIV test.
Among sexually experienced
teens, non-Hispanic Blacks
are more likely to have been
tested for HIV than Hispanics
and non-Hispanic Whites.
¦ More than half of sexually experienced
non-Hispanic Black
females (51%) and more than a
third of sexually experienced non-
Hispanic Black males (38%) have
been tested for HIV (Figure 1).
¦ Among sexually experienced
Hispanic teens, almost half of
girls (45%) have been tested
compared to just over a quarter
of boys (27%).
¦ Among sexually experienced
non-Hispanic White teens, more
than twice as many girls (36%)
as boys (18%) have had an HIV
test.
Most sexually experienced
teens who have had an HIV
test got the test at a private
doctor’s office/HMO or
clinic6.
¦ About one third of sexually experienced
teens who have been tested
for HIV received their most
recent test at a private doctor’s
office/HMO, and approximately
another one third had the test at
a clinic. The remaining third
obtained their test at a school,
hospital or "other place" (Figure
2).
¦ Approximately two in 10 sexually
experienced girls have had an
HIV test at a school, hospital, or
"some other place,"8 while
approximately four in 10 sexually
experienced boys have had an
HIV test at a school, hospital, or
"some other place." These girlboy
differences are statistically
significant.
¦ The place where sexually experienced
teens have had an HIV test
also varies significantly according
to race/ethnicity. Hispanic girls
(49%) are more likely than non-
Hispanic White (35%) and non-
Hispanic Black girls (41%) to
have had an HIV test at a doctor’s
office or HMO while non-
Hispanic White girls (22%) are
more likely than Hispanic (14%)
and non-Hispanic Black girls
(6%) to have had an HIV test at
the hospital.
¦ Among sexually experienced teen
boys, non-Hispanic Black males
(40%) are more likely than
Hispanic (26%) and non-
Hispanic White males (24%) to
have had an HIV test at a doctor’s
office or HMO, and non-
Hispanic Black males (22%) are
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2
FIGURE 1: Percent Sexually Experienced Teens Aged 15-19
Who Have Ever Had an HIV Test by Age Group and
Race/Ethnicity, 2002
10% 20% 30% 40% 50% 60%
Girls Boys
Non-Hispanic
Black
Non-Hispanic
White*
Hispanic*
Older Teens
(18-19)*
Younger Teens
(15-17)*
Total
(15-19)*
24%
45%
36%
38%
43%
41%
0%
25%
24%
27%
18%
38%
51%
* - difference between boys and girls statistically significant (p=.05).
3
less likely than Hispanic (39%)
and non-Hispanic White boys
(36%) to have had an
HIV test at a clinic.
Non-Hispanic White
boys (18%) are more
likely than Hispanic
(9%) and non-Hispanic
Black males (10%) to
have had an HIV test at
the hospital.
The primary reason
sexually experienced
teens give for having
an HIV test is to find
out if they are infected.
¦ About half of sexuallyexperienced
teens (46%
of girls and 53% of boys)
who were tested for HIV
report that their reason
for getting tested was
"just to find out if [they]
were infected" (Figure 3).
¦ Teen boys (40%) are significantly
more likely than girls (22%) to
cite "some other reason" for having
been tested.8
¦ Teen girls are twice as likely as
boys to obtain an HIV test
because of a doctor’s referral.
¦ Sexually experienced teens aged
15-17 (59% of boys and 56% of
girls) are more likely than sexually
experienced teens aged 18-19
(49% of boys and 41% of girls)
to say the reason they had an
HIV test was to determine their
HIV status.
¦ Reasons why sexually experienced
teens get tested for HIV vary by
race/ethnicity. Here we highlight
some of the more pronounced
differences. Hispanic boys (76%)
are more likely than non-
Hispanic Black (47%) and non-
Hispanic White boys (46%) to
report the reason they had an
HIV test was to determine if
FIGURE 2: Location of HIV Blood Test for Sexually
Experienced Teens Aged 15-19 That Have Been Tested for
HIV, 2002
Other Hospital
School Clinic Clinic Dr.'s Office/HMO
Girls* Boys*
18%
39%
38%
16%
2%
5%
29%
14%
8%
32%
* - difference between boys and girls statistically significant (p=.05).
Please note that due to rounding, the numbers do not equal 100%
FIGURE 3: Reasons for Having an HIV Test Among Sexually
Experienced Teens Aged 15-19 That Have Been Tested for HIV, 2002
10% 20% 30% 40% 50% 60%
Girls Boys
"Some other
reason"*
"To apply for health
or life insurance"
"For a hospitalization
or surgical procedure"*
"Because of a referral
by a doctor"
"Because you were pregnant
or because it was
part of prenatal care"
"Just to find out
if you were infected"
53%
1%
0%
28%
8%
46%
0%
N/A
4%
5%
1%
40%
22%
* - difference between boys and girls statistically significant (p=.05).
THE NATIONAL CAMPAIGN TO PREVENT TEEN PREGNANCY
www.teenpregnancy.org ¦ 202.478.8500 ¦ web@teenpregnancy.org
they were infected. Among girls,
non-Hispanic Black girls (52%)
are more likely than Hispanic
(38%) and non-Hispanic White
(47%) girls to report this as a
reason for getting an HIV test.
¦ Among sexually experienced
Hispanic teens, boys (76%) are
significantly more likely than
girls (38%) to report that they
had an HIV test to find out if
they were infected.
¦ Between 1995 and 2002, there
was a marked decrease in the
proportion of sexually experienced
Hispanic girls who had an
HIV test to determine their HIV
status (from 62% to 38%). Over
this same period, there was an
increase in the proportion of
Hispanic girls who had an HIV
test because they were pregnant
or receiving prenatal care (see the
second bullet below).
More than one in four sexually
experienced teen girls who
have been tested for HIV
report that they were tested
because they were pregnant
or receiving prenatal care.
¦ Between 1995 and 2002, there
was a slight increase in the percentage
of sexually experienced
teen girls who reported that they
had an HIV test "because [they]
were pregnant or because it was
part of prenatal care" (from 27%
to 28%).
¦ The proportion of sexually experienced
Hispanic girls who
reported that they had an HIV
test because they were pregnant
or receiving prenatal care
increased significantly from 23%
in 1995 to 45% in 2002.
¦ The proportion of non-Hispanic
Black and non-Hispanic White
sexually experienced girls who
reported pregnancy or prenatal
care as the reason for having an
HIV test decreased slightly from
1995 to 2002 (from 27% to
19% for non-Hispanic Black
girls and from 30% to 27% for
non-Hispanic White girls).
¦ The proportion of younger sexually
experienced teens (aged 15-
17) who reported that they had
an HIV test because they were
pregnant or receiving prenatal
care increased from 19% to 28%
between l995 and 2002, while
the proportion of older teens
(aged 18-19) who gave these reasons
for having an HIV test
decreased from 33% to 29%
during these years.
What it all means
Almost one in five (19%) new
AIDS cases are among young
adults.9 And given the interval
between HIV infection and the
development of AIDS, it is now
believed that a majority of the
young adults infected with AIDS
contracted HIV during their teen
years.10 All sexually experienced
teens are at significant risk of contracting
HIV, but the risk is greater
for young women and for racial and
ethnic minorities. For example, data
from a study of disadvantaged
youth in the mid-1990s showed
young women aged 16-21 had a
50% higher prevalence rate of HIV
infection than young men of the
same age.11
This analysis shows that a substantial
majority— two-thirds— of sexually
experienced teens have never
been tested for HIV. These teens
may not seek testing services
because they do not understand the
risk of contracting and spreading
HIV. Some studies suggest, for
example, that many teens are
unaware of the risks of unprotected
oral sex or the increased risk of contracting
HIV if one has another
STD.12 But there are other reasons
for the low testing status as well.
According to one survey of teens
aged 12-17, most young people do
not even know where to go for an
HIV test.13 Others may be afraid or
worry about confidentiality.
Among teens who do get tested, the
reasons vary. The most commonly
cited is simply wanting to know if
an infection is present. But the fact
that 40% of the boys who had been
tested said it was due to "some
other reason," a reason not on the
list of possible choices, suggests we
know less about motivation for testing
than we should.
The small proportion of sexually
active teens who have been tested
for HIV runs counter to professional
advice. For example, in 2003,
CDC announced its new
"Advancing HIV Prevention
Initiative," which calls for making
HIV testing a routine part of medical
care and stresses the importance
of early detection and treatment of
HIV. The low testing rate suggests
that health care providers be better
educated about the importance of
promoting awareness of the risks of
HIV/AIDS among teens and potential
prevention strategies. It is critical
that sexually experienced teens
be tested for HIV, receive counseling
about modifying behavior, and,
when needed, receive medical treatment
and advice.
THE NATIONAL CAMPAIGN TO PREVENT TEEN PREGNANCY
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About the Putting What Works to
Work Project
Putting What Works to Work (PWWTW)
is a project of the National Campaign to
Prevent Teen Pregnancy funded, in part, by
the Centers for Disease Control and
Prevention.Through PWWTW, the
National Campaign is translating research
on teen pregnancy prevention and related
issues into user-friendly materials for practitioners,
policymakers, and advocates. As
part of this initiative, the Science Says series
summarizes recent research in short, easyto-
understand briefs.
Author Information
This research brief was written by National
Campaign staff members Katherine
Suellentrop, Renee Huffman, and Christine
Flanigan.
About the National Campaign to
Prevent Teen Pregnancy
The National Campaign to Prevent Teen
Pregnancy is a nonprofit, nonpartisan
organization supported largely by private
donations.The National Campaign’s mission
is to improve the well-being of children,
youth, and families by reducing teen pregnancy.
The National Campaign celebrates
its 10th anniversary in 2005.When we
began in 1996, we set a goal of a one-third
reduction in the teen pregnancy rate in ten
years.Ten years later, it seems almost certain
that the nation will reach this goal.
Building on this great success, the National
Campaign’s new challenge to the nation for
the next decade will be to reduce the teen
pregnancy rate by another one-third.
Funding Information
This research brief was supported by
Grant Number U88/CCU322139-03 from
the Centers for Disease Control and
Prevention (CDC). Its contents are solely
the responsibility of the authors and do
not necessarily represent the official views
of CDC.
Data Sources
All statistics for 2002 were generated with
data from the National Survey of Family
Growth (NSFG) Cycle 6, a periodic national
survey on fertility-related issues conducted
by the National Center for Health
Statistics, Centers for Disease Control and
Prevention, U.S. Department of Health and
Human Services (HHS). NSFG data sets
on CD-ROM are available free of charge
from NCHS: visit
www.cdc.gov/nchs/nsfg.htm, call (301) 458-
4222, or e-mail nsfg@cdc.gov for more
information.
All statistics for 1995 were generated with
data from the National Survey of Family
Growth (NSFG), Cycle 5.
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Notes
1 Office of National AIDS Policy. (2000).
Youth and HIV/AIDS 2000: A New
American Agenda.Washington, DC:
Author.
2 Centers for Disease Control and
Prevention (CDC) (2004). HIV/AIDS
Surveillance Report, 2003. Vol. 15,
Atlanta: Department of Health and
Human Services, CDC: 1-40. Retrieved
August 24, 2005, from
http://www.cdc.gov/hiv/stats/2003Surve
illanceReport.pdf
3 Health Resources and Services
Administration (HRSA) HIV/AIDS
Bureau. (January, 2005). Youth and
HIV/AIDS. Retrieved August 8, 2005,
from http://hab.hrsa.gov/history/fact
2005/youth_and_hivaids.htm
4 Kaiser Family Foundation. (2005).The
HIV/AIDS Epidemic in the United
States, HIV/AIDS Policy Fact Sheet.
Retrieved September 20, 2005, from
http://www.kff.org/hivaids/upload/Fact-
Sheet-The-HIV-AIDS-Epidemic-in-the-
United-States-2005-Update.pdf
5 For boys, being "sexually experienced"
is defined as having been married, having
cohabited with a female, or having
answered yes to the following question:
"have you ever had sexual intercourse
with a female (sometimes this
is called making love, having sex, or
going all the way)?" For girls, being
"sexually experienced" is defined as
having been married, having cohabited
with a male, or having answered yes to
the following question:: "at any time in
your life, have you ever had sexual
intercourse with a man, that is, made
love, had sex, or gone all the way?"
For both boys and girls, "virgins" are
those who have never married, never
cohabited, and answered no to the
question regarding having had sexual
intercourse.
6 For location of an HIV blood test,
respondents were grouped based on
the answer to the question "Where
did you have that last blood test for
HIV?" They were grouped as having
received the test at a doctor’s
office/HMO if they chose the survey
response "Private doctor’s office" or
"HMO facility". Respondents were
grouped as having received the HIV
test at a clinic if they chose the
response, "community health clinic,
community clinic, public health clinic"
or "family planning or Planned
Parenthood clinic". Respondents were
grouped as having received the HIV
test at school if they chose the
response "school or school-based clinic".
Respondents were grouped as having
received the HIV test at a hospital
if they chose the response "Hospital
outpatient clinic", "Hospital emergency
room" or "Hospital regular room".
Respondents were grouped as having
received the most recent HIV test at
some other place if they chose the
response "employer or company clinic",
"urgent care center, urgi-care or
walk-in facility", "your worksite" (girls
only) or "some other place".
7 The term "statistical significance," refers
to the results of statistical testing to
measure whether observed differences
between groups (boys versus girls,
older versus younger teens, etc.) are
true difference in attitudes/behavior, or
are due to the particular teens included
in the survey, which is meant to be
representative of the U.S. teen population.
For the purposes of these analyses,
the threshold for statistical significance
is 0.05.That is, results are considered
significant if the "p value" (or
probability of the difference being just
a random occurrence) is equal to or
less than 5%.
8 Unfortunately, we do not know what
those "other reasons" were.
9 Futterman D (March, 2003).Youth and
HIV: the epidemic continues. PRN
Notebook, 8(1), 21-24.
10 Ibid.
11 U.S. Department of Health and
Human Services, CDC. (2005).
HIV/AIDS among Youth, May 2005.
Retrieved August 8, 2005 fromhttp://
www.cdc.gov/hiv/pubs/facts/youth.pdf.
12 Kaiser Family Foundation. (2000).
National Survey of Teens on HIV/AIDS.
Retrieved August 9, 2005 from
www.kff.org /youthhivstds/3092-
index.cfm. Ibid.
13 Ibid.
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6