Ten-year trends in HIV prevalence among visitors to public health centers under the National HIV Surveillance System in Korea, 2000 to 2009
BMC Public Health
Ten-year trends in HIV prevalence among visitors to public health centers under the National HIV Surveillance System in Korea, 2000 to 2009
Mee-Kyung Kee 0
Jin-Hee Lee 0
Jiyoung Whang 1
Sung Soon Kim 0
0 Division of AIDS, Center for Immunology and Pathology, Korea National Institute of Health , Osong, Cheongwon-gun Chungcheongbuk-do, 363-951 , South Korea
1 Division of HIV and TB control, Korea Centers for Disease Control and Prevention , Osong, Cheongwon-gun Chungcheongbuk-do, 363-951 , South Korea
Background: Korea saw a sharp increase in HIV diagnosis from 2000. This serious public health concern must be monitored diligently. We identified the characteristics and trends in HIV prevalence among visitors to public health centers (PHCs) from 2000 to 2009. Methods: We retrieved ten-year data of HIV tests from 253 PHCs. The HIV prevalence was analyzed by gender, age, nationality, region, and reason for HIV testing. Data were analyzed using logistic regression and score test for trend. Results: HIV prevalence among PHCs' visitors has rapidly increased for six years since 2000, decreased from 2006, and then remained stable. Approximately 50% of total HIV tests were performed for sexually transmitted infection risk group (STI RG), who were tested 1.4 times within a year. Women and the 20s comprised approximately 70% and 40% of PHCs' visitors, respectively. The prevalence of voluntary test takers was the highest and showed most rapid increase (P = 0.007), but that of prisoners declined (P = 0.003). The prevalence of STI RG was lower than those of the other groups and remained stable throughout the ten-year period (P = 0.606). Percentage of anonymous tests was 2-3% of a total HIV tests, but overall HIV-positive rate showed a rapid increase (P < 0.001). Conclusions: As voluntary or anonymous testing groups are actively engaged in learning their status of HIV, these groups showed the highest in HIV infection. Groups in the population with these characteristics should be located and encouraged to be tested, and offered anonymity. This study suggests that it is important to ascertain the characteristics of people choosing to take voluntary testing.
HIV prevalence; HIV surveillance; Voluntary test; Anonymous test; STI risk group
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Background
Since the first individual infected with HIV was
identified in South Korea in 1985, there have been a total of
8544 infected Koreans through 2011, with 7032 (82%)
living with HIV. Improving survival means increased
prevalence, even if incidence remains level, with a
resultant public health impact and an added population
disease burden. Among those Koreans infected with HIV,
approximately 92% were males and most had been
infected through sexual contact [1]. Most HIV tests have
been conducted at public health centers (PHCs), blood
centers, and hospitals. PHCs are instructed to conduct
HIV screening tests for sexually transmitted infection
(STI) risk group periodically and for volunteer groups
arbitrarily [2]. However, the number of testing in PHCs
has been reduced due to a change in the national HIV
testing policy from mandatory testing to voluntary
testing, since 1998 [3]. Therefore, currently only 0.4 million
HIV tests (5%) are being performed in PHCs while 4.8
million HIV tests (60%) are being performed in hospitals
due to both policy change and increasing number of
HIV tests for surgeries, prenatal exams, health
checkups in hospitals. HIV prevalence is an important tool to
describe the scale and changes in HIV infection trends
in a population. Characterizing this trend is critical for
evaluating policies for HIV infection prevention and
management, and for predicting future public health
strategy needs. Investigation of the characteristics and
trends of HIV infection were done based on the number
of HIV-diagnosed individuals in Korea. However, this
investigation can be limited when the scope and scale in
the population being tested are not considered.
Therefore, a surveillance system to calculate HIV prevalence
based on HIV test data has been developed and are
being used since 2005. With its ready availability of
record, HIV prevalence of those tested at PHCs was
calculated first [2]. Next, the methods to estimate HIV
prevalence of hospital patients and blood donors were
developed [4,5]. Thereby, we can estimate HIV
prevalence on a nationwide scale [6].
It is certain that main HIV testing institutions such as
hospitals, blood centers, and PHCs encounter
individuals, who are undergoing testing and share certain
characteristics. The visitors to PHCs for HIV testing
could have a different prevalence than those visiting
hospitals or blood centers [6]. PHCs provide HIV testing
not only for sexually transmitted infection (STI) risk
groups, such as commercial sex workers, but also for
persons wanting to be tested for HIV, local residents
with low accessibility to medical care, prisoners, partners
of HIV-infected individuals, and those wishing
anonymous testing. (...truncated)