Exploring the role of healthcare affordability in lifetime HIV testing among young adults in Tennessee, United States

HIV remains a major public health challenge in the United States, with about 20,000 of Tennesseans living with HIV and 14% unaware of their status. Young adults aged 18–34 years are disproportionately affected, and barriers such as healthcare affordability limit HIV testing rates. This study examines the relationship between healthcare affordability and lifetime HIV testing among young adults in Tennessee using the 2023 Behavioral Risk Factor Surveillance System (BRFSS) data. We conducted a cross-sectional analysis of 918 respondents aged 18–34 years from the Tennessee BRFSS 2023 survey, representing a weighted population of 1.4 million. The BRFSS uses a state-based random-digit dialing sampling design to collect data through telephone interviews. Weighted logistic regression was performed to assess associations between healthcare affordability and lifetime HIV testing, adjusting for key sociodemographic covariates. Interaction terms were included to assess effect modification by sex, race/ethnicity, age group, and general health status. Statistical significance was set at p < 0.05. Healthcare affordability was significantly associated with lifetime HIV testing. Participants reporting financial barriers were 42% less likely to undergo testing compared to those without affordability issues (OR = 0.58; 95% CI: 0.37-0.89; p-value = 0.014). Testing rates were higher among females, White non-Hispanics, and 30-34 age-group. Statistically significant interaction effects were observed for 25-29 age-group and the Asian non-Hispanic population. Healthcare affordability plays a critical role in lifetime HIV testing among young adults in Tennessee. Public health interventions should prioritize reducing financial barriers and targeting underserved populations to improve HIV testing.