To critically analyze scientific information presented in the popular media.

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https://learn.umuc.edu/d2l/le/dropbox/330802/688910/DownloadAttachment?fid=14178792

PLEASE COPY THIS LINK AND USE AS ARTICLE.

Project: Critique Paper and Peer Review Critique Paper
Addresses Course Outcome #1

  • recognize the use of the scientific method to weigh evidence, make decisions, and solve problems
  • apply knowledge of cellular and molecular processes to understand infectious disease mechanisms
  • synthesize knowledge of microbial pathogenesis and disease prevention methods and communicate this knowledge to the community

Purpose:
To critically analyze scientific information presented in the popular media.

Description:
In this assignment, you will be using the following skills:

  • critical evaluation of information presented in popular media
  • evaluation of the scientific method
  • evaluation of a website 
  • use of library databases/resources

WHAT YOU NEED TO DO (step by step):

STEP 1: Choose an article

  • Select an article from the list provided by your instructor. 
  • What to do if you want to choose your own article that is not on the “pre-approved” list:
  • Your article must come from a reputable web news source (such as sciencenews.org, sciencedaily.com, or newscientist.com), or from a published peer-reviewed scientific journal.
  • The article must explain a scientific study with specific details about that study. The article needs to provide actual scientific data, not just a general review of a topic.
  • You need to submit the link to the article for approval one week prior to the deadline (in the Article Critique conference).
  • Once you have submitted your choice, check back to see if it has been approved.

If you need additional information about your article, you can request a copy of the original scientific paper using the following link: request the original article with the original research from the library. (http://www.umuc.edu/library/delivered.shtml) This takes some time, so plan ahead!

SUBMISSION of STEP 1:

  • Post your topic choice in the ARTICLE CRITIQUE conference
  • Indicate your article choice in the subject line
  • Place the complete title and URL link in the text box of your post. If you chose your own article, please include an active URL link.

Please review the course schedule for the due date. Selecting an article on time is a component of your final grade. 

STEP 2: Choosing supporting references

Choose two additional supportive sources: choose at least one website and one source found in the UMUC library database.

Web Source:

  • Use the criteria found on the UMUC library web page when evaluating your Internet source: http://www.umuc.edu/library/guides/web.shtml.
  • Your Internet source must be from a reputable site such as NIH or CDC. Do not use personal websites, blogs, or sites that are for-profit (and thus may be biased).

Library Source:

  • If you need help locating a library source for your paper, please visit the UMUC library website http://www.umuc.edu/library/database/articles.shtml .
  • You should choose only sources that have the “full-text” version available.
  • Do not use abstracts as sources, these are NOT acceptable. Abstracts are simply a quick overview to help readers decide if they want to read the full paper.
  • You should only cite and use the FULL paper as a source. Some abstracts available in the library database do not have free links to the full paper. Do not use these, as there are many other free articles available through the UMUC database.  

STEP 3: Critical Analysis and Format

Format: 

Your critique should be 1,200 to 1,500 words, NOT including references, titles, etc. Your paper should be well-written, organized, and demonstrate a logical flow of information. It should also be spell-checked and grammatically correct.

Critique the article: There is a useful guide to Critical Analysis located in the Science Study Skills section of the classroom (located in the Course Content area under the link for Science Learning Center).

The UMUC guide to Critical Analysis will help you with the following:

  • how to identify and challenge starting assumptions
  • how to distinguish facts from opinions
  • how to make logical assumptions from the facts presented
  • how to identify strengths and weaknesses of the experiments and data
  • how to find and sort out conflicting claims
  • how to identify key information
  • how to identify missing information and consider alternative theories
  • how to determine the relevance of the study

You may also find Cornell’s guide to critiquing a research paper helpful.

You should present your critique in the following format:

  • A summary of the article. Be sure to include:
    • Background information that led to the study. In the background you should include basic information about the topic. For example, if your article describes a study about tuberculosis, you should include a description of the disease as well as a description of the microbe that causes the disease. What are the characteristics of the organism that causes tuberculosis? Disease course? Etc. … 
      • This is essentially a mini report. It should provide enough background information to give us an idea of why this research is important.  
      • You should be sure that you are using reliable sources for information. You should integrate your two sources into your paper (remember in-text citations!).
  • A discussion of the science. Be sure to include:
    • What is the goal of the study?
    • Summary of the experiments done (include things such as sample size, length of experiments, dosages, etc.).
      • This should be thorough, so that the reader knows exactly what was done without having to read the article. 
    • Include a brief summary of the findings of the study and why they are important.
    • Conclusions drawn from the study.
    • Are any future experiments planned?
  • Your opinion:
    • Faults, some things to consider:
      • Were there good controls? Why or why not?
      • Sample size too small or biased?
      • Conclusions not supported by experimental evidence?
      • Will this study apply to the general population?
    • If you find no faults, justify your reasons.
  • Real-World Application
    • Include your own thoughts and opinions on the topic. Relate the points/conclusions of the article to another issue in YOUR everyday life and/or to work you have completed in class. Be sure to make your contributions clear, such as “I believe …, I think …, etc.”
  • Citations. Cite all your references using APA format. http://www.umuc.edu/library/citationguides.shtml#apa  Include in-text citations. Use the following websites for help in formatting your citations:
  • http://www.umuc.edu/library/citationguides.shtml
  • http://www.umuc.edu/prog/ugp/ewp_writingcenter/writinggde/chapter5/print5-17.shtml

SUBMISSION: 

  • Post your completed review paper in the Article Critique conference. 
  • Copy and paste your critique into the response box (and not as an attachment). ONLY text posted within the response box will be graded. Please conserve the formatting when posting.

Please review the course schedule for the due date.

STEP 4: Analysis of a classmate’s critique

Read one other student’s critique that is different than the article you chose.

  • Provide your opinion about the quality of the science/experiments in the article. Explain fully.
  • What did you learn?
  • What other questions could be asked to further this information?
  • Provide other resources (websites) or additional information related to this topic.
  • Can you relate the information to something in your own life or the news?

This is worth 5% of your grade, so your response should be thought-provoking and contribute in some way. Short responses that basically say “good job” will receive only minimal partial credit.

Be sure to review comments made to your critique and respond appropriately.

Observational Study Medicine® OPEN

Indicators of self-reported human immunodeficiency virus risk and differences in willingness to get tested by age and ethnicity An observational study Brandon Brown, PhD, MPHa,

∗ , Logan Marg, MAa, Jenna LeComte-Hinely, PhDb, David Brinkman, MBAc,

Zhiwei Zhang, PhDd, Greer Sullivan, PhDa,e

Abstract There are many barriers that prevent people from receiving human immunodeficiency virus (HIV) testing; however, little is known about the impact of age and ethnicity on HIV testing. We explored differences in self-reported HIV risk and willingness to be tested in the 2014 Get Tested Coachella Valley Community Survey by age and ethnicity. Data were collected from 995 participants via survey methods (online, hard copy, and in person). Surveys asked about

demographics, sexual history, HIV testing history, thoughts on who should get tested, and future preferences for HIV testing. Most participants were women (62.5%), Hispanic (55.8%), and older than 50 years (51%). Participants who did not receive testing

said they did not do so because they did not perceive themselves as at risk of contracting HIV (51.8%). Many participants (24.1%) said they did not receive testing because their health care provider never offered them the HIV test. Participants were more likely to have been tested if they were between 25 and 49 years old, compared to participants aged 50 or older (70.2% vs 48.6%, respectively, P< .001). Participants who were not Hispanic or Latino were more likely to have had an HIV test compared to Hispanic or Latino participants (62.5% vs 51.1%, P< .001). Interventions are needed to reach older adults to address HIV testing and beliefs. These interventions must debunk beliefs among

physicians that older adults are not sexually active and beliefs among older adults that only certain populations are at risk of HIV.

Abbreviations: CDC = Centers for Disease Control and Prevention, GTCV = Get Tested Coachella Valley, HIV = human immunodeficiency virus, MSM = men who have sex with men.

Keywords: barriers to testing, Coachella Valley, human immunodeficiency virus testing

1. Introduction

More than 1 million people are living with human immunodefi- ciency virus (HIV) in the United States, yet up to 25% may be unaware of their status.[1] Approximately 70% of new HIV cases

Editor: Jimmy T. Efird.

This study was supported in part from UCLA/Charles R. Drew University of Medicine and Science Resource Centers for Minority Aging Research, Center for Health Improvement of Minority Elderly (RCMAR/CHIME) under NIH/NIA Grant P30-AG021684 and the UCLA Clinical and Translational Science Institute (CTSI) under NIH/NCATS Grant Number UL1TR001881.

The authors have no conflicts of interest to disclose. a School of Medicine, University of California, Riverside, Riverside, b Health Assessment and Research for Communities Inc, Palm Desert, c Desert AIDS Project, Palm Springs, d Department of Statistics, University of California, Riverside, e Borrego Community Health Foundation, CA. ∗ Correspondence: Brandon Brown, School of Medicine, University of California,

Riverside Center for Healthy Communities, 3333 14th Street, Riverside CA 92501 (e-mail: Brandon.brown@medsch.ucr.edu).

Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC- ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Medicine (2018) 97:31(e11690)

Received: 31 October 2017 / Accepted: 1 July 2018

http://dx.doi.org/10.1097/MD.0000000000011690

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are attributable to individuals unaware of their HIV-positive serostatus.[2] An intervention exists for this significant health problem: HIV testing. Attitudes and norms regarding HIV testing and intention to be tested play a role inHIV testing. Several studies have presented data on predictors of accepting HIV testing and intention to receive HIV testing in diverse groups, including Hispanic farmworkers, older adults, African American men who have sex with men (MSM), transgender women, and homeless women.[3–8] Stigma, education, provider recommendations, risk perceptions, and cost are among major factors contributing to accepting HIV testing and intention to receive HIV testing. Several existing barriers to HIV testing have been identified in

the literature: lack of knowledge and training, lack of patient acceptance, and competing priorities during medical visits.[9]

Stigma associated with HIV testing may be another barrier, because many individuals still see HIV as a disease affiliated with homosexuality and attributed to anal sex.[10] Studies and data related to barriers to HIV testing among aging populations, including low perceived HIV risk for patients among health care providers and at-risk individuals themselves, are lacking in the scientific literature. Some research has shown that older adults are less likely to

have ever been tested for HIV compared to younger adults.[11,12]

Although many older adults opt out of HIV testing,[4,13]

providers often do not offer HIV tests to older adults[14,15]

due to ageist assumptions about older adults’ sexual or drug use behaviors.[14,16] As a result, older adults infected with HIV aremailto:Brandon.brown@medsch.ucr.eduhttp://creativecommons.org/licenses/by-nc-nd/4.0http://creativecommons.org/licenses/by-nc-nd/4.0http://dx.doi.org/10.1097/MD.0000000000011690

[30]

Brown et al. Medicine (2018) 97:31 Medicine

more likely than younger people to go undiagnosed or be diagnosed later in the disease course.[13,17,18]

In one study, emergency department providers supported routine HIV testing, but did not want to administer tests due to barriers of inadequate time and resources and concerns regarding how to provide follow-up care.[19] Providers from community health centers reported similar feelings, noting additional problems of discomfort among all involved parties (provider, patient, and community) and inconsistent awareness of Centers for Disease Control and Prevention (CDC) recommendations regarding HIV testing.[20] However, patients interviewed in an emergency department overwhelmingly viewedHIV testing in the emergency department as a positive feature, with <5% stating that testing is undesirable due to fear of knowing one’s HIV status.[21] Patients in settings where HIV testing is not compulsory or routine may associate HIV testing with stigma, and thus either avoid HIV testing or find other reasons to go to clinics to disguise the true purpose of receiving HIV testing.[22]

Certain populations, such as African American MSM, may face additional negative perceptions of HIV testing besides stigma, namely homophobia, and lack of support from a homophobic community or family may discourage HIV testing.[23]

2. Impact of interventions on increasing HIV testing uptake

Despite CDC recommendations for routine, opt-out HIV testing for all patients in health care settings, research suggests that health care providers’ practices vary.[20,21] Few US interventions have focused on increasing HIV testing uptake, compared to interventions abroad. Local interventions have focused on social marketing and media technology. For example, an intervention conducted among Latinos living along the California-Mexico border used social marketing techniques, such as advertising in print, online, and radio in Spanish and offering a toll-free hotline service in Spanish, leading to increased HIV testing at clinics during the active campaign.[24] Another intervention offered a 15-minute video to people who declined HIV tests in an emergency department, prompting one third of participants to accept an HIV test.[25] In a community-based participatory research intervention delivered in Internet chat rooms frequented by MSM, an interventionist posted frequently about HIV testing and allowed other chat room users to send private messages to gain more information; the result was a significant increase in self-reported testing among the chat room participants.[26]

3. Setting

Riverside County is California’s fourth-largest county by population. More than half (63%) of all people living with HIV and acquired immunodeficiency syndrome in Riverside County are in the Coachella Valley.[27] Approximately 24% of people living with HIV in the Coachella Valley are aged 60 or older; racial and ethnic composition is 74.4% Caucasian and 19.7% Hispanic.[27] The incidence of HIV in the Coachella Valley has ranged from 27.2 to 1416.9 cases per 100,000 people, far greater than the estimated overall HIV incidence in California of 16.7 cases per 100,000.[27–29] In part, this high rate is due to the large population of older MSM living with HIV in Palm Springs. About half of Coachella Valley older adults are sexually active (53.0%), and the majority (88.4%) do not use a condom during sex because they are married or in a monogamous relationship, indicating a belief that their risk of contracting a

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sexually transmitted disease is relatively low. However, many of these individuals may not know their HIV status, because 72.3% have never been tested for HIV despiteMedicare coverage of testing.[30,31] Therefore, although free HIV testing is available to most, many individuals are neither offered nor seek testing. Consistent with recommendations from the CDC, numerous California State policies emphasize and attempt to increase routine, opt-out HIV testing for all patients in California health care settings.[32] However, as described above, numerous studies show significant barriers remain.

4. Present study

Little is known about the impact of age and ethnicity on the acceptance of HIV testing among health care providers and patients or on individuals’ intention to receive HIV testing. We explored differences in self-reported HIV risk and willingness to be tested in the 2014 Get Tested Coachella Valley (GTCV) Community Survey by age and ethnicity.[33] Our hypothesis is that older individuals and those taking the survey in Spanish are less likely to have had an HIV test.

5. Methods

Launched in 2014, GTCV seeks to combat the HIV epidemic in the Coachella Valley region of Southern California. This regional public health campaign strives to reduce HIV incidence by making HIV testing a routine medical practice and providing linkage to care for individuals who test positive.[31] GTCV uses multiple approaches to make HIV testing a routine medical practice, such as educating providers so that they ask patients to opt-in to HIV testing, educating patients so that they ask their providers to test them, and working with organizations to develop opt-out HIV testing protocols. Before GTCV, HIV testing was not performed routinely in the Coachella Valley, nor was it offered at wellness checks-ups. Although individuals with health insurance can receive free HIV testing, there remains a lack of consistency between individual health care providers and health care systems. Data were collected from participants aged 12 years or older from June 25 to July 15 using 3 modes of survey dissemination: online (surveymonkey.com), hard copy, and in person. Primary recruitment occurred through 46 GTCV partners, which included Coachella Valley municipalities, medical centers, businesses, and nonprofits. To avoid biasing the sample toward people who already get tested for HIV, sexual health andHIV service providers were excluded from recruitment efforts. Additional participants were recruited from churches, senior centers, and mobile HIV testing vans offering health screenings. The online survey was promoted via weekly posts on the Facebook and Twitter accounts of health assessment and research for communities, a health assessment and research nonprofit in Palm Desert; Facebook ads (English and Spanish) targeting people aged 13 or older living within 50 miles of Palm Desert (an estimated 400,000 Facebook users); and press releases (English and Spanish) distributed to various media channels. For in-person data collection, a trained, bilingual data collector went to specified locations for approximately 4 hour periods and invited people to participate in the survey. This method sought segments of the target population who were unlikely to be reached either by the online survey or static printed surveys displayed at various locations. For this project, 2 distinct target audiences were pursued: residents of the East Valley and adults older than 65 years.

Brown et al. Medicine (2018) 97:31 www.md-journal.com

The survey featured 18 questions assessing: demographics, media use, general health and medical care use, sexual history, HIV testing history, thoughts on who should get tested, and future preferences for HIV testing. All quantitative analyses were performed using Stata 12.0. Means, frequencies, and percentages were computed for all variables. Associations of aging and ethnicity with HIV testing history and testing perceptions were assessed using contingency tables and chi-square tests or Fisher exact tests. Differences in means were computed using F tests. Logistic regression was used to assess the unadjusted and adjusted association of age and ethnicity with selected sample characteristics. The final multivariate logistic regression model included variables significant in univariate analyses. To encourage people to take the survey, participants had the

chance to win one of ten $50 Visa gift cards, which can be used anywhere credit cards are accepted. The last page of the survey asked participants to enter their name and contact information (phone number or email) if they would like to be entered to win. For the purposes of this analysis, all participant contact information was removed. We received an exempt approval from the University of California, Riverside institutional review board due to the fact that all participants in this secondary data analysis were unidentifiable.

6. Results

Of 995 participants who took the survey, 953 statedwhether they had ever been tested for HIV in the past; 44% had never been tested (Table 1). Among those who received testing, 45.6% had their test at a doctor’s office, 25.1% at a community clinic, and 10.0% at a health fair. Most participants were women (62.5%), Hispanic (55.8%), and older than 50 (51%), and 33% took the survey in Spanish. A majority of participants were White (n=

Table 1

Human immunodeficiency virus testing history and related factors a

Overall Not Tested Tested

n (%) n (%) n (%)

Age ∗

48.5 (0.6) 51.5 (1.0) 45.5 (0.7) 12–24 109 (11.5) 54 (49.5) 55 (50.5) 25–49 357 (37.8) 103 (29.8) 243 (70.2) 50–64 304 (31.8) 126 (42.8) 168 (57.1) 65+ 175 (18.3) 108 (67.5) 52 (32.5)

Sex Male 359 (37.1) 138 (38.4) 221 (61.6) Female 593 (62.3) 280 (47.2) 313 (52.8)

Ethnicity Hispanic or Latino 519 (55.3) 254 (48.9) 265 (51.1) Other 419 (44.7) 157 (37.5) 262 (62.5)

Income <25,000 451 (49.7) 226 (50.1) 225 (49.9) 25,000+ 455 (50.2) 168 (36.9) 287 (63.1)

Sex partners†

Men only 541 (58.0) 178 (32.9) 363 (67.1) Women only 228 (24.4) 119 (52.2) 109 (47.8) Men and women 25 (2.7) 5 (20.0) 20 (80.0) None 139 (14.9) 104 (74.8) 35 (25.2)

Language English 666 (66.9) 243 (37.8) 400 (62.2) Spanish 329 (33.1) 176 (56.8) 134 (43.2)

∗ Values reflect M (SD) in first 3 columns.

† During prior 10 years. CI= confidence interval, HIV=human immunodeficiency virus, OR= odds ratio.

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585); 230 participants identified as other, 29 as African American, 19 as Asian or Pacific Islander, and 17 as American Indian or Alaska Native. Most participants (51%) made <$25,000 per year, whereas 19% made $75,000 or more. Participants were from Indio (18.1%), Palm Springs (16.7%), Coachella (11.4%), Cathedral City (10.3%), Mecca (9.7%), and Desert Hot Springs (7.3%). Regarding health care, 85% of participants reported having access to care when they needed it, 77.7% had a routine checkup with their doctor each year, and 53% received an annual flu shot. Participants were asked whom should be tested for HIV, and

876 responded. Few respondents (1.5%) reported that no one needs to be tested; 8.6% reported that only people with a high risk of HIV should be tested; 42% reported that all adults and teens need to be tested; and 48% reported that all sexually active people need to be tested. Participants who had ever been tested for HIV were asked

about their reasons for obtaining testing (Table 2). Among these participants, 141 (24.5%) received HIV testing because their health care provider offered to do the test; 120 (20.8%) received testing because it was offered free of charge at an event or community location; 117 (20.3%) received testing because of expert recommendations that everyone should receive HIV testing; and 106 (18.4%) received testing because they feared they were exposed to HIV. Reasons for receiving HIV testing also included having friends or family members who said testing was a good idea (8%), testing was required by an employer or insurer (6.1%), and the HIV-positive status of a partner (2.8%). Many participants (19.4%) cited various other reasons for receiving HIV testing (not shown in table) including pregnancy, blood donation, marriage, immigration, cheating spouse, surgery, routine testing, a new relationship, serious illness, other risks, mandatory testing, and responsibility.

mong 995 participants taking the community survey.

Unadjusted association Adjusted Association

P OR (95% CI) P OR (95% CI)

<.001 <.001 <.001 Ref <.001 Ref

2.40 (1.55, 3.73) 2.24 (1.35, 3.74) 1.36 (0.87, 2.11) 1.09 (0.63, 1.87) 0.49 (0.30, 0.81) 0.50 (0.26, 0.93)

.008 Ref <.001 Ref 0.69 (0.53, 0.91) 0.30 (0.19, 0.46)

<.001 Ref .212 Ref 1.60 (1.23, 2.08) 1.32 (0.85, 2.06)

<.001 Ref .658 Ref 1.72 (1.32, 2.24) 0.92 (0.64, 1.32)

<.001 Ref <.001 Ref 0.45 (0.33, 0.62) 0.17 (0.11, 0.28) 1.96 (0.72, 5.31) 1.32 (0.47, 3.75) 0.16 (0.11, 0.25) 0.22 (0.13, 0.37)

<.001 Ref .004 Ref 0.46 (0.35, 0.61) 0.52 (0.33, 0.81)http://www.md-journal.com

Table 2

Barriers and facilitators to human immunodeficiency virus testing by age categories.

Overall Young Adult Adult Old Adult Older Adult

Reason n % n % n % n % n %

Facilitators I was concerned I might have been exposed to HIV 106 18.4 11 20.4 40 16.5 36 21.4 17 32.7 My sexual partner is HIV positive 16 2.8 0 0.0 5 2.1 8 4.8 3 5.8 My health care provider offered to do the test 141 24.5 22 40.7 72 29.6 38 22.6 5 9.6 It was offered for free at an event or community location 120 20.8 17 31.5 56 23 29 17.3 14 26.9 It was required by my employer or insurer 35 6.1 1 1.9 17 7 13 7.7 3 5.8 Experts recommend that everyone get tested, so I did 117 20.3 16 29.6 44 18.1 43 25.6 12 23.1 My friend or family member said testing is a good idea, so I got tested 46 8.0 8 14.8 17 7 16 9.5 4 7.7 Other 112 19.4 6 11.1 56 23 37 22 8 15.4

Barriers Reason I don’t think I’m at risk of getting HIV 239 51.8 29 52.7 53 51.5 89 70.6 61 56.5 I’m not sexually active 98 21.3 21 38.2 5 4.9 26 20.6 39 36.1 My doctor or health care provider has never offered to test me for HIV 111 24.1 12 21.8 31 30.1 31 24.6 33 30.6 I don’t want my doctor or anyone else to judge me 15 3.3 4 7.3 2 1.9 3 2.4 6 5.6 I’m too embarrassed to get tested 11 2.4 3 5.5 1 1 1 0.8 6 5.6 I don’t want to know if I have HIV 12 2.6 1 1.8 4 3.9 1 0.8 6 5.6 I don’t know where to get tested 29 6.3 3 5.5 6 5.8 8 6.3 11 10.2 I don’t have the transportation needed to get to a testing site 11 2.4 0 0.0 2 1.9 6 4.8 3 2.8 I can’t afford to get tested 14 3.0 2 3.6 2 1.9 4 3.2 6 5.6 I don’t have health insurance 24 5.2 8 14.5 11 10.7 4 3.2 1 0.9 Other 35 7.6 5 9.1 13 12.6 8 6.3 8 7.4

Young adult=12–24 years old; adult=25–49 years old; old adult=50–64 years old; older adult=65 years old or older. HIV=human immunodeficiency virus.

Brown et al. Medicine (2018) 97:31 Medicine

Participants who never received HIV testing were asked questions to assess barriers that kept them from being tested. Among these participants, most did not receive testing because they did not perceive themselves as at risk of contracting HIV (51.8%). In addition, 111 (24.1%) participants said they did not receive testing because their health care provider never offered them the HIV test; 80% of untested participants said they would receive testing if offered by their provider. Others cited a lack of sexual activity as a reason for not receiving testing (n=98, 21.3%). Other reasons for not being tested included not knowing where to go for HIV testing (6.3%), lack of health insurance (5.2%), fear of negative judgment from health care providers or others (3.3%), not wanting to know one’s HIV status (2.6%), being too embarrassed to receive testing (2.4%), and a lack of transportation (2.4%). Significant differences by age occurred in participants’ reasons

for obtaining HIV testing and barriers that prevented them from receiving a test. Compared to participants younger than 50 years, significantly fewer participants aged 50 years or older accepted HIV testing when it was offered by a health care provider (P< .01). Significantly more participants aged 50 years or older, compared to those younger than 50 years, stated they are not at risk of HIV (P= .02) and are not sexually active (P= .01). Several factors were significantly related to the likelihood that

participants had received an HIV test (Table 1). Significant differences were found between the four age groups (P< .001), with the highest likelihood of testing (70.2%) for participants between 25 and 49 years old and the lowest likelihood of testing (32.5%) for participants aged 65 years or older. Men were more likely than women to have been tested (61.6% vs 52.8%, P= .008). Participants who were not Hispanic or Latino were also more likely to have had anHIV test compared to Hispanic or Latino participants (62.5% vs 51.1%, P< .001), as were participants who took the English version of the survey compared

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to those who took the Spanish version (62.2% vs 43.2%, P< .001). Participants with an annual income of $25,000 or greater were more likely than those making <$25,000 to have been tested (63.1% vs 49.9%, P< .001). Last, the sex of participants’ sex partners in the last 10 years was significantly associated with the likelihood of having had an HIV test (P< .001), with higher likelihood of testing for participants whose sex partners have been only men or both men and women than for those whose sex partners have been only women or those without sex partners. These significant factors were included in a multivariate logistic regression analysis, and the results were qualitatively similar to the univariate analyses except for ethnicity and income, whose adjusted associations became nonsignificant, possibly due to their collinearity with language.

7. Discussion

This study examined differences in age and ethnicity in self- reported HIV risk and willingness to receive HIV testing. Most untested participants did not believe they were at risk. Moreover, significantly fewer participants aged 50 years or older stated they were at risk of HIV compared to participants younger than 50 years, and they were less likely to be tested for HIV compared to participants aged 25 to 49 years. In addition, significantly fewer participants aged 50 years or older accepted HIV testing when it was offered by a health care provider, compared to younger participants. These findings are consistent with previous research showing

that older adults tend to underestimate their HIV risk and severely delay HIV testing or forgo testing altogether.[4,34,35] In a sample of at-risk older women, Akers et al.[36] found that participants who lacked interest in receiving HIV testing had a low perception of HIV risk. Also consistent with our findings are studies that showed older adults are more likely than younger

[37]

Brown et al. Medicine (2018) 97:31 www.md-journal.com

adults to be diagnosed with HIV later in the disease course, often following significant symptoms or hospitalization.[38]

Research also has suggested that older adults view HIV as a disease experienced primarily by young adults and that older adults are not the type of people who contract the disease.[13] This perception may contribute to older adults’ lower likelihood of receiving testing and lower perceptions of HIV risk. Our findings also show that many participants had not

received HIV testing because their health care providers had not offered the test. A majority stated they would get tested if offered by their health care provider. Thus, despite recommendations for opt-out HIV testing for all patients in health care settings from the CDC,[39] our results suggest that many GTCV participants’ physicians do not routinely offer opt-out HIV testing. Previous research revealed several barriers that prevent physicians from offering HIV tests to their patients. Brown et al.[40] examined data from physicians who participated in the GTCV and found that such barriers include competing priorities during clinical visits, limited time, discomfort with discussing HIV, and uneasiness about patient reactions. A review of the relevant literature found similar barriers.[9] The finding that many participants would get tested if their health care provider offered testing demonstrates the importance of physicians discussing and routinely recommending HIV testing. The results of this study show that Hispanic and Latino

participants were less likely to receive HIV testing than non- Hispanic or Latino participants. A national household survey in 2006 showed that the rate of HIV testing in the prior 12 months was higher among Hispanics than non-Hispanics.[41] However, other research suggested that Hispanics and Latinos have relatively low levels of HIV testing compared to African Americans and non-Hispanic Whites, and that Hispanics are more frequently diagnosed with HIV later in the disease course than non-Hispanic Whites.[42,43] Timely HIV testing is especially important for the Hispanic community in the United States because Hispanics are disproportionately affected by HIV.[44]

Barriers to timely HIV testing among Hispanics and Latinos may include a lack of acculturation and English language proficiency, stigma, undocumented status, lack of formal education on HIV, and inadequate health insurance.[45]

This study has several limitations. The use of a convenience sample in this study may have resulted in sampling bias. As such, it is not clear whether these findings are easily generalizable to areas of the United States beyond the Coachella Valley. Furthermore, most cities in the Coachella Valley are over- or underrepresented in our sample. Thus, it is unclear whether the findings are generalizable to cities not adequately represented in our sample. In addition, the self-reported HIV risk factors may have assumed that participants knew the risk factors for HIV, which may not have been the case. Some response categories overlapped one another, but since questions allowed for a single response, they were mutually exclusive. Moreover, while not collected, data on common HIV risk factors among participants, such as intravenous or other recreational drug use, multiple sex partners, and high-risk sexual behaviors would have been useful. Last, the survey did not include questions about HIV status or whether participants were ever asked to receive an HIV test. This study showed that most participants not tested for HIV

did not believe that they are at risk and that untested participants would get tested if the service was offered by their provider. These findings show that despite CDC recommendations for HIV testing, significant barriers remain. Health care providers should talk directly with their patients during clinical visits about HIV

5

prevention, HIV risk, and they should routinely offer HIV screening. Providers need training for how to have these discussions and effectively communicate risk. Interventions are especially needed to reach older adults to address HIV testing and unrealistic risk beliefs. These interventions must debunk beliefs among physicians that older adults are not sexually active and beliefs among older adults that only certain populations are at risk of HIV.[13]

8. Other information

A peer reviewed abstract of partial results from this study was accepted and presented at the 2016 American Public Health Association conference in Denver, Colorado. Thanks to Jo Gerrard for editorial support.

Author contributions

Conceptualization: Brandon Brown, David Brinkman. Formal analysis: Zhiwei Zhang. Funding acquisition: Jenna LeComte-Hinely. Methodology: Zhiwei Zhang. Project administration: Jenna LeComte-Hinely. Supervision: David Brinkman, Greer Sullivan. Writing – original draft: Brandon Brown. Writing – review and editing: Brandon Brown, Logan Marg, Jenna LeComte-Hinely, David Brinkman, Greer Sullivan.

References

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[25] Aronson ID, Marsch LA, Rajan S, et al. Computer-based video to increase HIV testing among emergency department patients who decline. AIDS Behav 2015;19:516–22.

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[27] Gardner A. Epidemiology of HIV/AIDS in Riverside County, 2013. County of Riverside, Department of Public Health, Epidemiology and Program Evaluation; 2014. Available at: http://www.rivcohivaids.org/ Portals/0/Riverside_County_HIV_AIDS_2016.pdf.Accessed July 8, 2017.

[28] Health Assessment Resource Center. Coachella Valley Community Health Monitor 2013: Executive Report. 2014. Available at: https:// www.emc.org/EmcOrg/assets/downloads/0016599.1.0-harccoachella valleyexecuti.pdf. Accessed June 17, 2017.

[29] Centers for Disease Control and PreventionEpidemiology of HIV Infection Through 2013. Centers for Disease Control and Prevention, Atlanta, GA:2013.

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Health Assessment Resource Center, Palm Desert, CA:2014. [31] Moyer VA. Screening for HIV: U.S. Preventative Services Task Force

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[40] Brown B, LeComte-Hinely J, Brinkman D, et al. Barriers to routine HIV testing in healthcare settings and potential solutions from the Get Tested Coachella Valley Campaign. J Acquir Immune Defic Syndr 2016;71: e127–8.

[41] Duran D, Beltrami J, Stein R, et al. Persons tested for HIV—United States, 2006. Morb Mortal Wkly Rep 2008;57:845–9.

[42] Centers for Disease Control and Prevention. Cases of HIV Infection and AIDS in the United States and Dependent Areas, 2007. 2009. Available at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-sur veillance-report-2007-vol-19.pdf. Accessed July 8, 2017.

[43] Nakashima AK, Campsmith ML, Wolfe MI, et al. Late versus early testing of HIV—16 sites, United States, 2000–2003. MMWR Morb Mortal Wkly Rep 2003;52:581–6.

[44] Centers for Disease Control and Prevention. Diagnoses of HIV Infection in the United States and Dependent Areas, 2015. 2016. Available at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveil lance-report-2015-vol-27.pdf. Accessed July 8, 2017.

[45] Centers for Disease Control and Prevention. HIV Among Hispanics/ Latinos. 2016. Available at: https://www.cdc.gov/hiv/pdf/group/ racialethnic/hispaniclatinos/cdc-hiv-latinos.pdf. Accessed July 8, 2017.http://www.rivcohivaids.org/Portals/0/Riverside_County_HIV_AIDS_2016.pdfhttp://www.rivcohivaids.org/Portals/0/Riverside_County_HIV_AIDS_2016.pdfhttps://www.emc.org/EmcOrg/assets/downloads/0016599.1.0-harccoachellavalleyexecuti.pdfhttps://www.emc.org/EmcOrg/assets/downloads/0016599.1.0-harccoachellavalleyexecuti.pdfhttps://www.emc.org/EmcOrg/assets/downloads/0016599.1.0-harccoachellavalleyexecuti.pdfhttp://nccc.ucsf.edu/wp-content/uploads/2014/03/State_HIV_Testing_Laws_Quick_Reference.pdfhttp://nccc.ucsf.edu/wp-content/uploads/2014/03/State_HIV_Testing_Laws_Quick_Reference.pdfhttp://nccc.ucsf.edu/wp-content/uploads/2014/03/State_HIV_Testing_Laws_Quick_Reference.pdfhttps://gettestedcoachellavalley.org/wp-content/uploads/2016/06/Get-Tested-2015-Annual-Report-compressed.pdfhttps://gettestedcoachellavalley.org/wp-content/uploads/2016/06/Get-Tested-2015-Annual-Report-compressed.pdfhttps://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdfhttps://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdfhttps://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdfhttps://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdfhttps://www.cdc.gov/hiv/pdf/group/racialethnic/hispaniclatinos/cdc-hiv-latinos.pdfhttps://www.cdc.gov/hiv/pdf/group/racialethnic/hispaniclatinos/cdc-hiv-latinos.pdf

  • Indicators of self-reported human immunodeficiency virus risk and differences in willingness to get tested by age and ethnicity
    • Outline placeholder
      • 1 Introduction
      • 5 Methods
      • 6 Results
      • 7 Discussion
      • Author contributions
    • References

Please refer to the course schedule for due date.