Predicting HIV testing in low threshold community contexts among young African American women living in the Southern United States

Abstract

ABSTRACT Southern U.S. African American women have disproportionately high HIV infection rates, and increasing HIV testing is a prevention priority. Research suggests that optimal testing conditions involve reaching out to community members and offering free tests in private, supportive contexts with minimal delays for results. These conditions were implemented with young African American women (N\u2009=\u2009223, M age\u2009=\u200920.4 years) living in disadvantaged areas of a Southern U.S. city to identify participant characteristics associated with test choice. Participants were recruited using Respondent Driven Sampling. Structured field interviews assessed personal and social network characteristics, sexual practices, substance use, and behavioral impulsivity (assessed by a delay discounting task). A free HIV test was then offered, and test choice was the outcome variable. Testing was accepted by 69%, which exceeded the national lifetime test rate for this population by 7.4% (p\u2009<\u2009.05). All were sero-negative. Test refusal (31%) was associated with poorer educational performance, greater impulsivity (discounting), less social network encouragement to use birth control (ps\u2009<\u2009.05), and lower engagement in sexual risk behaviors (p\u2009<\u2009.10). Test choice did not differ by substance involvement. Thus, low threshold community testing promoted acceptance among this priority population, although a minority with specific characteristics likely need additional incentives for test acceptance.