What makes a teen get tested? A case of urban based sample of adolescents

Objective: Urban teens disproportionately impacted by HIV may not seek HIV testing. The objectives of this study are to determine factors that impact HIV testing among sexually active and non-sexually active teens seeking care in an urban academic setting; whether teens with high levels of self-efficacy are more likely to receive HIV testing; and whether an teen's ability to cope impacts positive attitudes toward testing. Methods: We conducted a cross-sectional survey of 228 HIV negative adolescent and young adult participants age 12-21 who received care in an academic urban primary care clinic in Baltimore, Maryland. Results: Most youth reported being sexually active (N=146, 64%) and reported having been tested at that day's visit (N=135, 85%). Provider recommendation was significantly associated with higher odds of testing among sexually active teens (OR 3.5, 95% CI 1.07-11.7) and those with no prior sexual history (OR 5.89, 95% CI 1.40-24.9), while high HIV stigma was associated with lower odds of testing (OR 0.17, 95% CI 0.04-0.77) among youth with no prior sexual history. Sexually active teens with a positive attitude toward HIV testing were more likely to be older (late: 6.3 (1.0-40)), report intention to be tested in 6 months (OR 7.11, 95% CI 1.48-34.2), and have higher HIV coping self-efficacy (OR 1.12, 95% CI 1.00-1.26). Conclusions: Provider recommendation may be the most important independent factor for testing in teens, regardless of sexual history, while HIV-related stigma may be an important factor for teens with no prior sexual history and thus may be perceived to have little or no risk for HIV acquisition. In sexually active youth, older age, intention to be tested for HIV and the ability to cope with a positive diagnosis likely dictates adolescent attitudes toward engagement in HIV testing, although it may not directly correspond with HIV testing behavior.