People who live in rural areas in the United States have lower odds of lifetime as well as past-year HIV testing compared with their urban-dwelling counterparts, according to recent research published in Sexually Transmitted Diseases.

Previous research indicated that people in US rural areas deal with certain challenges related to HIV testing and health care, including a decrease in testing among men and young adults.

People in rural areas are also experiencing an increased incidence of HIV (especially in the South and Midwest) and disparities in the HIV care continuum. The study authors set out to examine the effectiveness of updated HIV screening guidelines in rural populations compared to urban populations.

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The research is based on data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), which is administered by the CDC as a cross-sectional survey of health-related behaviors, conditions, and services.

Participant responses (N=250,579) to the survey were evaluated along the lines of whether respondents had ever had an HIV test (then if they had had one in the past year) and in what location the last HIV test occurred.

Past-year testing analysis showed that 24.5% (n=8161) of people living in urban areas had received an HIV test vs 20.2% (n=2349) of rural residents. Lifetime HIV testing was reported by more urban respondents (26.9%, n=39,938) than rural respondents (21.5%, n=13,837).

Study authors also found a tendency for people in rural areas to have less lifetime (odds ratio [OR], 0.85; 95% CI: 081 – 0.90) and past-year HIV testing (OR, 84; 95% CI, 0.74 – 0.95) than no testing. Hospital/emergency rooms (aOR: 1.41, 95% CI: 1.23-1.62) and clinics (adjusted odds ratio, 1.21; 95% CI, 1.02 – 1.24) were locations that showed higher odds of HIV testing in rural locations than doctors’ offices.

Limitations of the study include missing data from respondent surveys, issues related to the validity of self-reported behaviors, and limited generalizability for minors and people who are homeless, in the military, incarcerated, or in nursing homes.

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Study authors report “it is imperative that providers in rural areas routinely offer HIV testing to their patients.” They also note “targeted interventions are needed to remove structural barriers in rural communities such as long distances to clinics and low availability of free HIV testing at clinics serving the un- or under-insured.”


Henderson ER, Subramaniam DS, Chen J. Rural-urban differences in HIV testing among US adults: findings from the behavioral risk factor surveillance system [published online June 29, 2018]. Sexually Transmitted Diseases. doi:10.1097/OLQ.0000000000000888