Background:  Washington, DC has the highest AIDS rates in the US. Routine HIV screening is an essential step towards identifying HIV⁺ persons, yet missed opportunities continue. This analysis identifies characteristics of persons who have visited health-care providers in the past year but were not offered an HIV test.

Methods:  National HIV Behavioral Surveillance data on non-intravenous drug user (IDU), heterosexual individuals at high risk for HIV based on geographical/social connection to areas with elevated AIDS and poverty were collected from December 2006 to October 2007 via respondent-driven sampling. RDSAT, Stata, and SAS characterized HIV testing behaviors and missed opportunities in this community-based sample; missed opportunities for HIV testing were assessed using uni-, bi-, and multivariable methods. Preliminary HIV testing was conducted using OraQuick.

Results:  Of 750 participants, the majority was over 30 years (61.4%), African American (92.3%), and had an annual household income of <$9,999 (60.0%); 5.2% (95%CI 2.9 to 7.2%) tested preliminary HIV⁺, and women were more likely to be positive than men (6.3% vs 3.9%). Of HIV⁺ participants, 47.4% did not know their HIV status prior to the study. Most participants (87.9%) reported having been HIV tested at least once and 60.9% within the past year. Although three-quarters (79.7%) had seen a health-care provider in the past 12 months, only half (50.6%) were offered an HIV test. Of the 16 who screened newly HIV⁺, 71.4% had seen a health-care provider in the past 12 months; 50% (n = 8 of 16) of those were not offered an HIV test at the last visit. For men, after adjusting for age, substance use, corrections history, depression, and number of sex partners, those with current health insurance were less likely to be offered an HIV test the last time they saw a health-care provider (OR 0.48, 95%CI 0.25 to 0.94). After adjusting for these confounders, women >35 years and having >1 sex partner in the last 12 months were less likely to be offered an HIV test the last time they saw a healthcare provider (OR 0.60, 95%CI 0.39 to 0.93 and OR 0.56, 95%CI 0.38 to 0.91, respectively).

Conclusions:  Despite widespread testing availability, considerable missed opportunities for identification and linkage into HIV care remain. Men with insurance may be misperceived as low risk for HIV and less likely to be offered testing as well as older women and those with multiple sex partners. Use of universal screening for HIV is necessary to decrease missed opportunities for screening and care.