Since the AIDS epidemic was first identified in the United States in 1981, population-based AIDS surveillance has been used to track the progression of the HIV epidemic1. To monitor this epidemic, all states and territories conduct name-based surveillance of AIDS cases2. This allows for a unified and consistent method by which to track the epidemic nationally. However, HIV surveillance is not nationally conducted and, when it is, standard methods are not utilized. With the onset of highly active antiretroviral therapy (HAART), the number of AIDS cases has decreased dramatically as a result of people living longer. As a result, HIV surveillance has become necessary in order to monitor and track the disease. In January 1993, the Centers for Disease Control and Prevention (CDC) decided to evaluate the potential deterrent effect of implementing HIV surveillance on HIV testing2 through the HIV Testing Survey (HITS). Between 1995 and 2001 HITS was conducted in three waves in 23 different states.
As part of its HIV/AIDS surveillance efforts, the HIV Epidemiology Program was funded by CDC to conduct HITS with persons at high risk for HIV in the City, and later in the County, of Los Angeles. The 2002 HITS was conducted in 15 cities or states across the country with men who have sex with men (MSM), injection drug users (IDU), and heterosexual STD clinic clients, using a standard protocol. Its goal was to understand the influence of HIV surveillance policies on testing behaviors and to examine other correlates of HIV testing, risk behavior, and prevention service utilization. The 2002 study focused on Black and Latino populations.
- Assess the reasons and barriers that influence persons to seek or avoid HIV testing
- Assess knowledge of state policies for HIV surveillance
- Assess HIV testing patterns among persons at-risk for HIV
- Conduct behavioral surveillance among persons at risk for HIV
- Evaluate the representativeness of HIV surveillance data
- Examine level and types of exposure to HIV prevention services
- Collect data for local HIV prevention and community planning
HITS was an anonymous cross-sectional survey conducted in Los Angeles from August 2002 through January 2003. The core HITS study populations were MSM, IDUs, and high-risk heterosexuals with the goal of recruiting 100 eligible participants from each population. These populations were chosen because they represented those populations most at risk for contracting the disease. MSM were recruited from nine gay bars/clubs, IDUs were recruited from six needle exchange sites and two street corners, and HET were recruited from two Los Angeles County public sexually transmitted disease clinics. Participants at the IDU and MSM sites were randomly sampled by rolling dice and approaching the "nth" person. Eligible STD patients were sequentially selected in order of registration. Eligibility for the survey was limited to those who had had sexual intercourse or injected drugs in the previous 12 months. Persons indicating they had previously tested HIV positive were later excluded from the analysis. Consenting individuals were given a 25-40 minute interviewer-administered survey and compensated $25 in cash. Over the 6-month study period, 346 eligible persons were enrolled, included 123 MSM, 102 IDUs and 121 high-risk heterosexuals.
Qiana R. Butler, MPH, Study Coordinator
Nina T. Harawa, MPH, PhD, Study Epidemiologist
- Centers for Disease Control and Prevention. Guidelines for National Human Immunodeficiency Virus Case Surveillance, Including Monitoring for Human Immunodeficiency Virus Infection and Acquired Immunodeficiency Syndrome. MMWR 1999, 48 (RR13); 1-28.
- Centers for Disease Control and Prevention. HIV Testing Survey (HITS) Protocol. January 2002.