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HIV Counseling and Testing -- United States, 1993

Counseling and testing (CT) are important components of state and local human immunodeficiency virus (HIV)-prevention programs (1). Analysis of national data sources indicates that HIV-antibody tests are obtained from a variety of testing sites, including private physicians, hospitals, and outpatient clinics (66.7%), and publicly funded sites (33.1%) (2). This report uses data from CDC's 1993 Behavioral Risk Factor Surveillance System (BRFSS) to examine variations in rates of use of private and public HIV CT sites by state.

In 1993, a total of 49 states and the District of Columbia participated in the BRFSS, a state-specific population-based, random-digit-dialed telephone survey that collects information monthly from U.S. adults aged greater than or equal to 18 years. Thirteen questions about HIV/AIDS-related knowledge and attitudes and HIV-antibody testing history during the preceding year were asked only to respondents aged less than or equal to 65 years. In 1993, a total of 84,039 persons responded to these questions (state-specific range: 993 to 3667). The state-specific median percentage of 82% of eligible respondents completed interviews (3). Data for each state were weighted by demographic characteristics and by selection probability; results are representative of persons aged 18-65 years in each state. Confidence intervals for percentages and estimated numbers of persons tested were based on standard errors that accounted for complex survey design (4).

A median of 25.5% of persons (range: 14.4% {Iowa} to 37.5% {Alaska}) answered yes to the question: "Except for donating or giving blood, have you ever had your blood tested for the AIDS virus infection?" Table_1. The number (weighted estimate) of adults who had ever been tested for HIV was highest in California (6.3 million).

A median of 9.6% of persons (range: 4.1% {Maine and South Dakota} to 16.9% {District of Columbia}) reported obtaining HIV-antibody tests primarily for diagnostic reasons * Table_1. Persons categorized as having obtained diagnostic HIV-antibody tests were identified by one of three responses to the question "What was the main reason you had your last AIDS blood test?": "to find out if infected," "because of referral by a doctor or health department or sex partner," or "for routine checkup ** ."

In 43 states and the District of Columbia, at least 50.0% (median: 60.9%) of respondents had obtained their last diagnostic test from a private physician, health maintenance organization, or private outpatient clinic Table_2. A median of 16.2% of persons (range: 5.0% {North Dakota} to 37.6% {Mississippi}) had obtained their last diagnostic test at a publicly funded prevention site (including health departments; AIDS, sexually transmitted disease {STD}, or tuberculosis clinics; and drug-treatment programs).

The estimated number of persons who obtained a diagnostic test at a publicly funded site during the preceding year correlated with the number of tests reported to CDC's HIV Counseling and Testing System by publicly funded sites in each state (5) (correlation coefficient=0.96; p less than 0.01).

A median of 60.7% of persons who had obtained their most recent diagnostic HIV-antibody test at a publicly funded site (range: 30.8% {New Jersey} to 95.7% {Oklahoma}) received counseling with their test results Table_2. In comparison, a median of 28.2% of persons who had obtained their tests from a private site (range: 7.7% {Kentucky} to 77.3% {Oklahoma}) also received counseling. In most (90%) of the reporting areas, the number of persons who received counseling with their HIV test results was greater than or equal to 1.5 times greater for persons tested at publicly funded sites than those tested at private sites. Reported by the following BRFSS coordinators: S Jackson, MPA, Alabama; P Owen, Alaska; B Bender, Arizona; J Senner, PhD, Arkansas; B Davis, PhD, California; M Leff, MSPH, Colorado; M Adams, MS, Connecticut; F Breukelman, Delaware; C Mitchell, District of Columbia; D McTague, MS, Florida; E Pledger, MPA, Georgia; F Newfield, MPH, Hawaii; C Johnson, MPH, Idaho; B Steiner, MS, Illinois; R Guest, MPH, Indiana; P Busick, Iowa; M Perry, Kansas; K Bramblett, Kentucky; D Hargrove-Roberson, MSW, Louisiana; D Maines, Maine; A Weinstein, MA, Maryland; R Lederman, MPH, Massachusetts; H McGee, MPH, Michigan; N Salem, PhD, Minnesota; E Jones, MS, Mississippi; J Jackson-Thompson, PhD, Missouri; P Smith, Montana; S Huffman, Nebraska; E DeJan, Nevada; K Zaso, MPH, New Hampshire; G Boeselager, MS, New Jersey; P Jaramillo, MPA, New Mexico; C Maylahn, MPH, New York; G Lengerich, MD, North Carolina; D Young, MS, North Dakota; E Capwell, PhD, Ohio; N Hann, MPH, Oklahoma; J Grant-Worley, MS, Oregon; J Romano, MPH, Pennsylvania; J Hesser, PhD, Rhode Island; M Lane, MPH, South Carolina; B Miller, South Dakota; D Ridings, Tennessee; R Diamond, MPH, Texas; R Giles, Utah; R McIntyre, PhD, Vermont; S Carswell, MA, Virginia; K Holm, MPH, Washington; F King, West Virginia; E Cautley, MS, Wisconsin. Behavioral and Prevention Research Br, Div of Sexually Transmitted Diseases and HIV Prevention, National Center for Prevention Svcs; Behavioral Risk Factor Surveillance Br, Office of Surveillance and Analysis, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings from the 1993 BRFSS document a high degree of state-specific variability in self-reported HIV-antibody tests in the United States. This variability may reflect state-specific differences in such factors as the prevalence of HIV infection and HIV testing in high-risk groups, the presence and impact of HIV-prevention programs, and age distribution. The BRFSS estimates of the number of persons last tested for voluntary or diagnostic reasons at a publicly funded clinic correlated highly with estimates from CDC's HIV Counseling and Testing System, and the median percentage of respondents ever tested for HIV (25%) is consistent with estimates based on CDC's National Health Interview Survey (22%).

Health-care visits to seek and obtain HIV tests are important opportunities to counsel persons about the risk for HIV infection and methods to reduce such risk (1). The data in this report indicate that, in most states, approximately threefold more persons reported having obtained their HIV test from a private provider than from a public site; however, persons who had obtained their test from a private provider were substantially less likely to have reported receiving counseling than those who obtained tests at a public site. This finding underscores the need for physicians and other health-care providers in private settings to offer HIV counseling at the time patients receive their HIV test results.

The findings in this report are subject to at least two limitations. First, the sample size of persons who reported having had an HIV-antibody test in individual states did not enable stratification by other respondent characteristics. For example, state-specific sample sizes precluded analysis to determine whether specific high-risk populations that obtained HIV-antibody testing also received counseling. Second, because the BRFSS is a telephone-based system, some persons at high risk for HIV infection most likely were excluded from the survey.

The BRFSS is a unique source for information about HIV-antibody testing behaviors of U.S. adults -- particularly patterns of HIV testing outside of public clinics -- and can be used both at the federal and state levels to improve HIV-prevention and intervention programs. Questions about CT in the 1993 BRFSS were developed based on input from state health departments; subsequent BRFSS surveys may incorporate additional HIV-related behavioral questions.

References

  1. Hinman AR. Strategies to prevent HIV infection in the United States. Am J Public Health 1991;81:1557-9.

  2. CDC. HIV counseling and testing services from public and private providers -- United States, 1990. MMWR 1992;41:743,749-52.

  3. CDC. 1993 BRFSS quality control report. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1994.

  4. Shah BV. Software for Survey Data Analysis (SUDAAN) version 5.30 {Software documentation}. Research Triangle Park, North Carolina: Research Triangle Institute, 1989.

  5. CDC. HIV counseling and testing data system: national profile, 1993. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1994.

* For this study, diagnostic HIV-antibody tests were defined as those administered primarily to learn infection status rather than voluntary tests to qualify for insurance, military induction, immigration, marriage license application, or employment. 

** This response was included in "diagnostic" reasons to avoid excluding respondents who initiated a routine examination to determine whether they were infected with HIV.



Table_1
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TABLE 1. Percentage of persons surveyed and estimated number of persons who reported ever having an HIV-antibody test and who
reported their last HIV test was primarily for diagnostic reasons * -- Behavioral Risk Factor Surveillance System, United
States, 1993
=============================================================================================================================
                                                                                           Persons who reported
                                          Persons who reported ever                   their last HIV-antibody test was
                                          having an HIV-antibody test                 primarily for diagnostic reasons +
                                       -----------------------------------         ------------------------------------------
                                                   Estimated                                     Estimated
                       Sample                         no.                                           no.
Reporting area          size       %    (95% CI &)  (thousands)   (95% CI)           %     (95% CI)  (thousands)  (95% CI)
-----------------------------------------------------------------------------------------------------------------------------
Alabama                 1758     18.5   (+/-2.0%)       473        (+/- 52)         9.0   (+/-1.5%)       231       (+/- 38)
Alaska                  1414     37.5   (+/-3.8%)       135        (+/- 16)        13.5   (+/-2.5%)        48       (+/-  9)
Arizona                 1318     23.7   (+/-3.2%)       561        (+/- 92)         8.9   (+/-2.5%)       211       (+/- 64)
Arkansas                1374     23.8   (+/-2.6%)       339        (+/- 39)         9.7   (+/-1.7%)       138       (+/- 24)
California              3122     32.2   (+/-2.0%)      6327        (+/-423)        14.5   (+/-1.5%)      2860       (+/-300)
Colorado                1553     30.5   (+/-2.4%)       677        (+/- 58)        13.6   (+/-1.8%)       302       (+/- 40)
Connecticut             1494     20.3   (+/-2.3%)       433        (+/- 50)         6.3   (+/-1.4%)       134       (+/- 29)
Delaware                1751     29.5   (+/-2.4%)       131        (+/- 12)        14.1   (+/-2.0%)        62       (+/-  9)
District
  of Columbia           1288     24.6   (+/-2.8%)       102        (+/- 12)        16.9   (+/-2.4%)        70       (+/- 11)
Florida                 2364     33.2   (+/-2.2%)      2748        (+/-199)        15.8   (+/-1.8%)      1306       (+/-152)
Georgia                 1847     24.4   (+/-2.4%)      1043        (+/-105)         8.5   (+/-1.5%)       364       (+/- 65)
Hawaii                  1893     30.3   (+/-2.7%)       208        (+/- 20)        11.9   (+/-1.7%)        82       (+/- 12)
Idaho                   1474     24.4   (+/-2.8%)       149        (+/- 18)        10.2   (+/-2.0%)        62       (+/- 13)
Illinois                1753     23.3   (+/-2.2%)      1673        (+/-165)         8.8   (+/-1.5%)       634       (+/-106)
Indiana                 1675     20.4   (+/-2.2%)       717        (+/- 79)         7.8   (+/-1.4%)       273       (+/- 50)
Iowa                    1405     14.4   (+/-2.0%)       241        (+/- 34)         5.5   (+/-1.3%)        92       (+/- 22)
Kansas                  1196     16.8   (+/-2.2%)       254        (+/- 34)         7.2   (+/-1.5%)       108       (+/- 23)
Kentucky                1888     21.0   (+/-2.1%)       491        (+/- 52)         7.4   (+/-1.3%)       173       (+/- 30)
Louisiana               1354     26.5   (+/-2.7%)       685        (+/- 74)        10.9   (+/-1.8%)       282       (+/- 47)
Maine                    993     15.4   (+/-2.5%)       119        (+/- 20)         4.1   (+/-1.2%)        32       (+/-  9)
Maryland                3667     29.1   (+/-1.7%)       942        (+/- 60)        14.6   (+/-1.4%)       474       (+/- 47)
Massachusetts           1321     23.9   (+/-2.5%)       927        (+/-101)         9.6   (+/-1.8%)       375       (+/- 71)
Michigan                2041     27.4   (+/-2.1%)      1620        (+/-129)        11.3   (+/-1.4%)       669       (+/- 85)
Minnesota               2804     22.1   (+/-1.7%)       612        (+/- 50)         8.6   (+/-1.1%)       237       (+/- 32)
Mississippi             1311     27.7   (+/-2.7%)       430        (+/- 44)        13.3   (+/-2.0%)       205       (+/- 32)
Missouri                1195     22.5   (+/-2.6%)       714        (+/- 85)        11.0   (+/-2.0%)       349       (+/- 65)
Montana                  974     23.2   (+/-2.9%)       113        (+/- 16)         9.4   (+/-2.2%)        46       (+/- 11)
Nebraska                1410     17.8   (+/-2.1%)       170        (+/- 21)         4.2   (+/-1.1%)        40       (+/- 11)
Nevada                  1543     36.8   (+/-2.7%)       290        (+/- 24)        15.7   (+/-2.0%)       124       (+/- 16)
New Hampshire           1262     24.5   (+/-2.7%)       176        (+/- 20)         9.3   (+/-1.8%)        66       (+/- 13)
New Jersey              1271     24.5   (+/-2.7%)      1232        (+/-140)        10.8   (+/-2.0%)       543       (+/-105)
New Mexico              1082     30.2   (+/-3.2%)       286        (+/- 33)        13.7   (+/-2.5%)       130       (+/- 24)
New York                1984     26.0   (+/-2.3%)      3025        (+/-278)        12.4   (+/-1.6%)      1440       (+/-196)
North Carolina          1928     23.8   (+/-2.2%)      1047        (+/-101)         8.8   (+/-1.4%)       388       (+/- 61)
North Dakota            1418     17.9   (+/-2.3%)        68        (+/-  9)         6.4   (+/-1.3%)        24       (+/-  5)
Ohio                    1105     21.1   (+/-2.8%)      1445        (+/-197)         6.5   (+/-1.8%)       443       (+/-129)
Oklahoma                1192     19.3   (+/-2.7%)       378        (+/- 57)         8.7   (+/-1.9%)       171       (+/- 39)
Oregon                  2411     27.1   (+/-2.0%)       493        (+/- 38)        12.2   (+/-1.4%)       221       (+/- 27)
Pennsylvania            1932     21.2   (+/-2.0%)      1589        (+/-152)         7.7   (+/-1.3%)       574       (+/- 97)
Rhode Island            1459     30.9   (+/-2.7%)       197        (+/- 21)        13.6   (+/-2.0%)        86       (+/- 14)
South Carolina          1738     27.6   (+/-2.6%)       625        (+/- 66)        13.1   (+/-2.0%)       296       (+/- 48)
South Dakota            1422     16.3   (+/-2.2%)        66        (+/-  9)         4.1   (+/-1.2%)        17       (+/-  5)
Tennessee               2515     20.3   (+/-1.7%)       644        (+/- 56)         7.1   (+/-1.1%)       225       (+/- 35)
Texas                   2132     32.0   (+/-2.4%)      3488        (+/-282)        10.4   (+/-1.5%)      1131       (+/-172)
Utah                    1527     19.1   (+/-2.2%)       189        (+/- 22)         8.2   (+/-1.5%)        81       (+/- 15)
Vermont                 1583     19.3   (+/-2.1%)        69        (+/-  8)         6.7   (+/-1.3%)        24       (+/-  5)
Virginia                1520     32.8   (+/-2.7%)      1371        (+/-122)        13.5   (+/-1.9%)       563       (+/- 83)
Washington              2219     28.3   (+/-2.0%)       908        (+/- 66)        14.3   (+/-1.6%)       460       (+/- 50)
West Virginia           1873     18.2   (+/-1.9%)       202        (+/- 22)         6.4   (+/-1.2%)        70       (+/- 14)
Wisconsin               1286     21.6   (+/-2.5%)       658        (+/- 80)         7.5   (+/-1.6%)      2227       (+/- 50)

Median                               24.0%                                         9.6%
-----------------------------------------------------------------------------------------------------------------------------
* For this study, diagnostic HIV tests were defined as those administered primarily to learn infection status rather
  than voluntary tests to qualify for insurance, military induction, immigration, marriage license application, or
  employment.
+ Persons in this category were identified by one of three responses to the question "What was the main reason you had
  your last AIDS blood test?": "to find out if infected," "because of referral by doctor or health department or sex
  partner," or "for routine checkup." The response "for routine checkup" was included in "diagnostic" reasons to avoid
  excluding respondents who initiated a routine examination to determine whether they were infected with HIV.
& Confidence interval.
=============================================================================================================================

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Table_2
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TABLE 2. Percentage of persons surveyed who ever had an HIV-antibody test and estimated number of persons who reported that their last HIV-antiboby test was for
diagnostic reasons *, by site -- United States, Behavioral Risk Factor Surveillance System, 1993
========================================================================================================================================================================
                                        Persons whose last diagnostic HIV-antibody                             Persons whose last diagnostic HIV-antibody
                                           test was obtained at a private site +                         test was obtained at a publicly funded prevention site &
                             --------------------------------------------------------------------   --------------------------------------------------------------------
                                                 Estimated                    %                                          Estimated                  %
                    Sample     %                    no.                    Received                    %                    no.                  Received
Reporting area       size    Tested  (95% CI &)  (thousands)  (95% CI)     counseling  (95% CI)     Tested  (95% CI)    (thousands)   (95% CI)   counseling  (95% CI)
------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Alabama               172     53.8   (+/- 8.3%)       124       (+/- 28)      24.0     (+/- 9.6%)    36.9   (+/- 8.1%)       85       (+/- 24)      57.5     (+/-14.1%)
Alaska                212     55.6   (+/- 9.9%)        27       (+/-  7)      28.2     (+/-11.8%)    18.6   (+/- 8.2%)        9       (+/-  4)      53.5     (+/-25.2%)
Arizona               107     55.6   (+/-14.2%)       117       (+/- 43)      35.3     (+/-19.0%)    13.1   (+/- 7.4%)       28       (+/- 15)      56.8     (+/-27.9%)
Arkansas              140     53.6   (+/- 9.2%)        74       (+/- 18)      28.5     (+/-10.4%)    30.6   (+/- 8.8%)       42       (+/- 15)      43.9     (+/-17.6%)
California            480     58.7   (+/- 5.4%)      1679       (+/-241)      27.3     (+/- 6.8%)    13.9   (+/- 3.9%)      397       (+/-119)      75.7     (+/-15.7%)
Colorado              238     64.2   (+/- 6.9%)       194       (+/- 33)      23.2     (+/- 7.1%)    11.3   (+/- 4.6%)       34       (+/- 15)      81.8     (+/-15.9%)
Connecticut           100     68.1   (+/-10.1%)        92       (+/- 25)      29.8     (+/-12.9%)     7.9   (+/- 5.7%)       11       (+/-  8)      68.0     (+/-32.7%)
Delaware              241     53.0   (+/- 7.1%)        33       (+/-  6)      24.5     (+/- 8.5%)    37.5   (+/- 6.8%)       23       (+/-  6)      51.3     (+/-12.4%)
District
  of Columbia         218     60.5   (+/- 7.2%)        42       (+/-  8)      50.7     (+/- 9.5%)    19.5   (+/- 5.8%)       14       (+/-  4)      66.0     (+/-16.3%)
Florida               383     56.8   (+/- 5.5%)       742       (+/-112)      24.6     (+/- 6.6%)    24.8   (+/- 5.2%)      324       (+/- 79)      58.8     (+/-11.5%)
Georgia               160     60.9   (+/- 9.2%)       222       (+/- 51)      22.1     (+/- 9.2%)    25.8   (+/- 7.7%)       94       (+/- 31)      54.9     (+/-17.1%)
Hawaii                273     44.9   (+/- 7.3%)        37       (+/-  8)      15.6     (+/- 7.8%)    18.2   (+/- 6.4%)       15       (+/-  6)      45.4     (+/-18.9%)
Idaho                 157     59.6   (+/-10.1%)        37       (+/- 11)      18.5     (+/-10.9%)    24.3   (+/- 8.3%)       15       (+/-  6)      61.4     (+/-19.1%)
Illinois              177     69.8   (+/- 7.4%)       442       (+/- 88)      24.8     (+/- 8.4%)    13.8   (+/- 5.6%)       88       (+/- 38)      53.9     (+/-21.8%)
Indiana               139     60.5   (+/- 9.3%)       165       (+/- 38)      25.5     (+/-10.3%)    17.6   (+/- 7.0%)       48       (+/- 21)      77.8     (+/-18.9%)
Iowa                   86     52.8   (+/-11.8%)        48       (+/- 15)      27.9     (+/-15.0%)    24.0   (+/-11.1%)       22       (+/- 12)      82.3     (+/-23.0%)
Kansas                 95     54.8   (+/-10.9%)        59       (+/- 18)      29.3     (+/-14.7%)    16.8   (+/- 7.8%)       18       (+/-  9)      40.5     (+/-24.0%)
Kentucky              140     62.9   (+/- 9.1%)       109       (+/- 25)       7.7     (+/- 5.0%)    18.9   (+/- 7.4%)       33       (+/- 14)      55.2     (+/-21.3%)
Louisiana             155     70.4   (+/- 8.5%)       199       (+/- 40)      30.3     (+/- 9.4%)    13.0   (+/- 5.7%)       37       (+/- 17)      46.2     (+/-23.6%)
Maine                  50     65.1   (+/-15.2%)        21       (+/-  7)      44.1     (+/-18.3%)    19.3   (+/-13.6%)        6       (+/-  5)      93.3     (+/-13.4%)
Maryland              527     76.5   (+/- 4.2%)       362       (+/- 42)      25.6     (+/- 4.8%)     8.9   (+/- 2.9%)       42       (+/- 15)      63.9     (+/-15.7%)
Massachusetts         129     66.7   (+/- 9.4%)       250       (+/- 58)      31.9     (+/-11.0%)     7.7   (+/- 5.1%)       29       (+/- 20)      65.9     (+/-35.6%)
Michigan              254     62.1   (+/- 6.7%)       415       (+/- 68)      30.6     (+/- 7.9%)     9.5   (+/- 3.8%)       63       (+/- 26)      59.4     (+/-20.8%)
Minnesota             247     55.6   (+/- 6.9%)       132       (+/- 23)      28.2     (+/- 8.4%)     7.1   (+/- 3.9%)       17       (+/- 10)      85.1     (+/-14.0%)
Mississippi           187     46.0   (+/- 7.9%)        94       (+/- 22)      25.3     (+/-10.0%)    37.6   (+/- 8.2%)       77       (+/- 21)      44.8     (+/-13.7%)
Missouri              133     61.6   (+/- 9.6%)       215       (+/- 47)      25.2     (+/- 9.6%)    11.6   (+/- 5.9%)       40       (+/- 22)      52.7     (+/-27.2%)
Montana                83     62.1   (+/-12.7%)        28       (+/-  9)      37.5     (+/-15.8%)    19.4   (+/-10.3%)        9       (+/-  5)      75.2     (+/-21.4%)
Nebraska               66     73.3   (+/-11.3%)        29       (+/-  9)      35.7     (+/-16.3%)    13.6   (+/- 8.5%)        5       (+/-  4)      72.5     (+/-28.4%)
Nevada                250     55.1   (+/- 7.1%)        68       (+/- 13)      21.2     (+/- 7.7%)    17.2   (+/- 5.4%)       21       (+/-  7)      32.0     (+/-15.2%)
New Hampshire         112     49.2   (+/-10.2%)        33       (+/-  9)      32.9     (+/-13.7%)    10.5   (+/- 5.7%)        7       (+/-  4)      52.9     (+/-28.4%)
New Jersey            129     79.7   (+/- 8.0%)       433       (+/- 95)      29.8     (+/-10.1%)     7.8   (+/- 5.2%)       42       (+/- 29)      30.8     (+/-28.3%)
New Mexico            145     57.1   (+/- 9.5%)        74       (+/- 19)      32.3     (+/-12.3%)    16.3   (+/- 6.8%)       21       (+/-  9)      51.9     (+/-22.8%)
New York              266     61.5   (+/- 6.8%)       885       (+/-152)      33.9     (+/- 8.1%)    22.2   (+/- 5.8%)      320       (+/- 97)      66.0     (+/-14.6%)
North Carolina        174     61.5   (+/- 8.0%)       239       (+/- 51)      37.5     (+/-11.2%)    30.4   (+/- 7.5%)      118       (+/- 34)      53.8     (+/-14.4%)
North Dakota           91     46.7   (+/-11.0%)        11       (+/-  3)       9.5     (+/- 9.4%)     5.0   (+/- 4.5%)        1       (+/-  1)      64.7     (+/-42.9%)
Ohio                   65     62.7   (+/-15.1%)       278       (+/- 94)      26.1     (+/-13.5%)    12.3   (+/- 9.0%)       54       (+/- 42)      60.7     (+/-36.0%)
Oklahoma               95     65.0   (+/-10.0%)       111       (+/- 32)      77.3     (+/-11.2%)    16.0   (+/- 8.1%)       27       (+/- 15)      95.7     (+/- 8.4%)
Oregon                306     48.4   (+/- 6.2%)       107       (+/- 18)      26.9     (+/- 7.7%)    23.6   (+/- 5.4%)       52       (+/- 14)      75.1     (+/-12.4%)
Pennsylvania          161     63.1   (+/- 8.4%)       363       (+/- 77)      26.0     (+/- 9.5%)     5.4   (+/- 3.5%)       31       (+/- 21)      74.0     (+/-30.5%)
Rhode Island          206     63.3   (+/- 8.0%)        55       (+/- 12)      29.3     (+/- 9.5%)     7.1   (+/- 3.4%)        6       (+/-  3)      56.6     (+/-24.6%)
South Carolina        205     57.7   (+/- 8.4%)       171       (+/- 36)      30.3     (+/- 9.6%)    28.0   (+/- 7.7%)       83       (+/- 27)      49.3     (+/-16.5%)
South Dakota           65     59.6   (+/-14.7%)        10       (+/-  4)      32.2     (+/-18.7%)     6.3   (+/- 5.9%)        1       (+/-  1)      86.7     (+/-25.7%)
Tennessee             199     73.2   (+/- 6.8%)       164       (+/- 30)      38.5     (+/- 9.0%)    18.9   (+/- 6.1%)       42       (+/- 15)      58.7     (+/-18.5%)
Texas                 250     53.3   (+/- 7.8%)       603       (+/-131)      27.3     (+/- 9.8%)    15.0   (+/- 5.8%)       69       (+/- 71)      71.5     (+/-19.9%)
Utah                  141     60.5   (+/- 9.3%)        49       (+/- 12)      31.9     (+/-10.6%)    20.0   (+/- 7.7%)       16       (+/-  7)      72.3     (+/-18.1%)
Vermont               120     62.8   (+/-10.1%)        15       (+/-  4)      25.5     (+/-10.6%)    11.1   (+/- 6.8%)        3       (+/-  2)      59.3     (+/-31.1%)
Virginia              209     59.5   (+/- 7.3%)       335       (+/- 63)      18.6     (+/- 7.4%)    16.2   (+/- 5.5%)       92       (+/- 35)      64.8     (+/-18.2%)
Washington            343     67.2   (+/- 5.5%)       309       (+/- 42)      28.2     (+/- 6.5%)     9.6   (+/- 3.3%)       44       (+/- 16)      78.3     (+/-14.2%)
West Virginia         120     66.9   (+/- 9.6%)        47       (+/- 11)      21.8     (+/- 9.6%)    14.8   (+/- 7.6%)       10       (+/-  6)      32.9     (+/-26.4%)
Wisconsin             103     48.5   (+/-11.4%)       110       (+/- 35)      15.2     (+/-14.7%)    14.0   (+/- 8.2%)       32       (+/- 20)      68.6     (+/-27.2%)

Median                        60.9%                                         28.2%               16.2%                                       60.7%
------------------------------------------------------------------------------------------------------------------------------------------------------------------------
* For this study, diagnostic HIV tests were defined as those administered primarily to learn infection status rather than voluntary tests to qualify for
  insurance, military induction, immigration, marriage license application, or employment.
+ Private physician, health maintenance organization, or private outpatient clinic.
& Including health departments; AIDS, sexually transmitted disease, or tuberculosis clinics; and drug-treatment programs.
@ Confidence interval.
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