Assessment of HIV testing of urban injection drug users: Implications for expansion of HIV testing and prevention efforts

Objectives. We sought to determine the extent of HIV testing among urban injection drug users (IDUs) to assess whether an expansion of targeted testing programs would be consistent with national goals to identify previously undetected infections. Methods. IDUs in 5 US cities (Oakland, Calif; Chicago, III; Hartford and New Haven, Conn; and Springfield, Mass) were recruited either by chain referral or time-location sampling. The IDUs were questioned about HIV testing, and factors associated with HIV testing were analyzed. Results. Ninety-three percent of 1543 IDUs had been tested. Among those tested but who did not report having been told that they were HIV seropositive, 90% had been tested within the past 3 years. Women and syringe-exchange customers were more likely to have been tested ever and in the recent past. We estimated the number of undetected infections among urban IDUs in the United States to be less than 40000. Conclusions. Testing for HIV has reached the vast majority of IDUs through the current options. Expending scarce prevention money to expand testing of IDUs is unlikely to be productive. Instead, resources should be used for proven HIV-prevention strategies including syringe exchange, drug treatment, and secondary prevention for those who are HIV positive.