Recorded presentation

Stephanie L. Taylor, PhD, MPH¹, Arleen A. Leibowitz, PhD², Paul Ong, PhD², and Paul Simon, MD, MPH³. (1) RAND, 1700 Main St, PO Box 2138, Santa Monica, CA 90407, 310-393-0411 x 7925, staylor@rand.org, (2) Public Policy, UCLA, Public Policy Bldg, Los Angeles, CA 90095, (3) Office of Health Assessment and Epidemiology, County of Los Angeles, Department of Health Services, 313 North Figueroa Street Room 127, Los Angeles, CA 90012

Background: Geographic variations in HIV-testing site locations exist. However, the relationship between test site proximity and individuals’ HIV-testing has gone relatively unexamined. We addressed two questions, “Are people living further away from public HIV-testing sites less likely to test at those sites?”. If so, “Are they more likely to forgo HIV-testing or do they simply test elsewhere?”

Methods: Data were from the 1999 Los Angeles County Health Survey, a random probability sample of adults (n=5,414). ArcGIS software estimated distances. Travel time was estimated using the distance measures and reports of car ownership. Nested logistic regression analyses were used. Models included interactions terms to estimate if distance was a greater barrier to testing for persons: 1) without insurance, 2) having lower incomes, 3) having higher-risk sex behaviors, or 4) without regular sources of care. Models included weights and ten individual characteristics related to HIV-testing.

Results: Persons living further away from public test sites were less likely to test for HIV, especially among those with lower incomes. Persons with higher-risk sex behaviors living further from public test sites were more likely to test at physician offices or elsewhere. These results held regardless of whether travel distance or travel time was examined. However, uninsured persons were affected only by their travel time – some went without testing while others tested at non-physician sites instead of utilizing public sites.

Conclusions: The distance to public HIV-testing sites matters. Providing accessible testing opportunities to those who are poor, uninsured, or have higher-risk sex behaviors might increase HIV-testing.

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