Influence of Rurality on HIV Testing Practices Across the United States, 2012–2017

  • Lam Tran
  • Phoebe TranEmail author
  • Liem Tran
Original Paper


In the US, HIV testing has been key in the identification of new HIV cases, allowing for the initiation of antiretroviral treatment and a reduction in disease transmission. We consider the influence of living in a rural area (rurality) on HIV testing between different US regions and states as existing work in this area is limited. Using the 2012–2017 Behavioral Risk Factor Surveillance Systems surveys, we explored the independent role of rurality on having ever been tested for HIV and having a recent HIV test at the national, regional, and state levels by calculating average adjusted predictions (AAPs) and average marginal effects (AMEs). Suburban and urban areas had higher odds and AAPs of having ever been tested for HIV and having a recent HIV test compared to rural areas across the US. The Midwest had the lowest AAPs for both having ever been tested for HIV (17.57–20.32%) and having a recent HIV test (37.65–41.14%) compared to other regions. For both questions on HIV testing, regions with the highest AAPs had the greatest rural–urban differences in probabilities and regions with the lowest AAPs had the smallest rural–urban difference in probabilities. The highest rural–urban testing disparities were observed in states with high AAPs for HIV testing. HIV testing estimates were higher in urban compared to rural areas at the national, regional, and state level. This study examines the isolated influence of rurality on HIV testing and identifies specific US areas where future efforts to increase HIV testing should be directed to.


HIV testing Rurality BRFSS Logistic regression Average adjusted predictions Average marginal effects 



There was no funding for this study.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human or animals participants performed by any of the authors. All data that was used is publicly available and anonymized.

Informed Consent

This is not applicable to the study.


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Authors and Affiliations

  1. 1.Department of BiostatisticsMichigan School of Public HealthAnn ArborUSA
  2. 2.Department of Chronic Disease EpidemiologyYale UniversityNew HavenUSA
  3. 3.Deparment of GeographyUniversity of TennesseeKnoxvilleUSA

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