Population-Level Trends and Determinants of HIV Testing Among U.S. Women Reporting HIV Risk Behavior From 2016 to 2020: A Repeated Cross-sectional Study

Racial and ethnic disparities in HIV among women in the United States persist. Testing is a key component of HIV prevention and treatment, yet national testing rates and demographic differences among women with increased vulnerability are unclear. A secondary repeated cross-sectional analysis of Behavioral Risk Factor Surveillance System data from female respondents spanning years 2016-2020 was performed to assess HIV testing among those reporting behaviors that increase the potential for acquiring HIV. Survey weighted logistic regression was used to model the predicted probability of an HIV test in the past 12 months. Among the weighted sample ( N = 20,336), there was a 37.1% probability of an HIV test in the past 12 months. Non-Hispanic Black women had the highest probability (56.2%), and testing in the 25-34 and 35-44 years age groups was consistently below 50% in each year of the analysis. Overall, women with health care coverage (vs. without coverage) were more likely to be tested for HIV; however, no significant difference in testing by insurance status was observed for Non-Hispanic women of color in supplemental analysis. Our study underscores HIV testing gaps among U.S. women with increased HIV vulnerability, across all demographics, indicating missed opportunities and emphasizing the need for targeted, accessible, and engaging HIV prevention methods.