You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.
 

Table 1  

Characteristic No. of persons (column %) PR (95% CI)
Tested for HIV infection* Aware of PrEP*
Total (row %) 310,954 (100.0) 85,288 (27.4) N/A
Age group, yrs
13–24 80,166 (25.8) 22,494 (28.1) Ref
25–49 183,396 (59.0) 54,887 (29.9) 1.07 (1.05–1.08)
≥50 44,226 (14.2) 7,500 (17.0) 0.60 (0.59–0.62)
Gender §
Female 133,308 (42.9) 19,308 (14.5) Ref
Male 172,769 (55.6) 63,207 (36.6) 2.53 (2.49–2.56)
Transgender 3,517 (1.1) 2,414 (68.6) 4.74 (4.62–4.86)
Race
White 185,173 (59.5) 38,181 (20.6) Ref
Black 20,488 (6.6) 8,054 (39.3) 1.91 (1.87–1.94)
Other 10,110 (3.3) 3,978 (39.3) 1.91 (1.86–1.96)
Population group**
Heterosexual female 88,234 (28.4) 15,469 (17.5) Ref
Gay, bisexual, and other male who has sex with males 66,657 (21.4) 42,312 (63.5) 3.62 (3.57–3.68)
Person who injects drugs 11,937 (3.8) 3,444 (28.9) 1.65 (1.59–1.70)
Heterosexual male 65,276 (21.0) 14,010 (21.5) 1.22 (1.20–1.25)
Test setting ††
Health care setting 181,348 (58.3) 32,846 (18.1) Ref
Non–health care settings 109,231 (35.1) 38,637 (35.4) 1.95 (1.93–1.98)
U.S. Census region
Northeast 32,232 (10.4) 18,109 (56.2) Ref
Midwest 17,139 (5.5) 5,159 (30.1) 0.54 (0.52–0.55)
South 173,218 (55.7) 23,259 (13.4) 0.24 (0.24–0.24)
West 75,479 (24.3) 37,095 (49.1) 0.87 (0.86–0.89)
U.S. territories§§ 12,886 (4.1) 1,666 (12.9) 0.23 (0.22–0.24)

Table 1. Preexposure prophylaxis awareness among Hispanic persons tested for HIV infection, by demographic characteristics, U.S. Census region, and test setting — United States, 2019

Abbreviations: CI = confidence interval; N/A = not applicable; PR = prevalence ratio; PrEP = preexposure prophylaxis; Ref = referent group.

 

* Valid HIV tests for this analysis included tests for which a test result (i.e., positive or negative) was known and had a nonmissing value on PrEP awareness. PrEP awareness was assessed by HIV test providers documenting a response to the following question, ”Has the client ever heard of PrEP?”

For age, the numbers of records missing or invalid are as follows: 3,166 (1.0%) in the column “Tested for HIV infection” and 407 (0.5%) in the column “Aware of PrEP.”

§ For gender, the numbers of records missing or invalid are as follows: 1,360 (0.4%) in the column “Tested for HIV infection” and 359 (0.4%) in the column “Aware of PrEP.”

Race categories include the following: “White” = Hispanic White; “Black” = Hispanic Black or African American; and “Other” = Hispanic persons of other races including Asian, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and multirace. For race, the numbers of records missing or invalid are as follows: 95,183 (30.6%) in the column “Persons tested for HIV infection” and 35,075 (41.1%) in the column “Aware of PrEP.”

** For population groups, the numbers of records missing or invalid are as follows: 23,002 (7.4%) in the column “Tested for HIV infection” and 3,399 (4.0%) in the column “Aware of PrEP.” In addition, the numbers of records for “other” excluded from this table are as follows: 55,848 (18.0%) in the column “Tested for HIV infection” and 6,654 (7.8%) in the column “Aware of PrEP.”

†† Mobile settings and unknown settings are excluded.

§§ Includes Puerto Rico and the U.S. Virgin Islands.

Table 2  

Characteristic Eligible for a PrEP referral* Referred to a PrEP provider* PR (95% CI)
no. (column %) no. (row %)
Total 111,644 (100.0) 24,506 (22.0) N/A
Age group, yrs
13–24 32,698 (29.3) 7,088 (21.7) Ref
25–49 68,061 (61.0) 15,538 (22.8) 1.05 (1.03–1.08)
≥50 10,333 (9.3) 1,717 (16.6) 0.77 (0.73–0.80)
Gender §
Female 39,339 (35.2) 5,828 (14.8) Ref
Male 69,966 (62.7) 17,981 (25.7) 1.73 (1.69–1.78)
Transgender 1,920 (1.7) 581 (30.3) 2.04 (1.90–2.19)
Race
White 58,960 (52.8) 14,318 (24.3) Ref
Black 11,235 (10.1) 1,509 (13.4) 0.55 (0.53–0.58)
Other 4,795 (4.3) 1,037 (21.6) 0.89 (0.84–0.94)
Population group**
Heterosexual females 32,429 (29.0) 4,980 (15.4) Ref
Gay, bisexual, and other male who has sex with males 34,583 (31.0) 13,645 (39.5) 2.57 (2.50–2.64)
Person who injects drugs 6,777 (6.1) 1,166 (17.2) 1.12 (1.06–1.19)
Heterosexual male 27,814 (24.9) 3,243 (11.7) 0.76 (0.73–0.79)
Test setting ††
Health care settings 54,105 (48.5) 13,323 (24.6) Ref
Non–health care settings 53,574 (48.0) 10,916 (20.4) 0.83 (0.81–0.85)
U.S. Census region
Northeast 28,325 (25.4) 4,353 (15.4) Ref
Midwest 8,445 (7.6) 2,775 (32.9) 2.14 (2.05–2.23)
South 45,878 (41.1) 12,363 (26.9) 1.75 (1.70–1.81)
West 25,450 (22.8) 4,540 (17.8) 1.16 (1.12–1.21)
U.S. territories§§ 3,546 (3.2) 475 (13.4) 0.87 (0.80–0.95)

Table 2. Referral to preexposure prophylaxis providers among Hispanic persons who were eligible for PrEP, by demographic characteristics, U.S. Census region, and test setting — United States, 2019

Abbreviations: CI = confidence interval; N/A = not applicable; PR = prevalence ratio; PrEP = preexposure prophylaxis; Ref = referent group.

 

* Eligibility for a PrEP referral was assessed by HIV test providers documenting a response to the question, ”Was the client eligible for a referral to a PrEP provider?” Referral to a PrEP provider was assessed by HIV test providers documenting a response to the question, “Was the client given a referral to a PrEP provider?” HIV tests with missing values for eligibility for PrEP referral and referral to a PrEP provider were excluded.

For age, the numbers of records missing or invalid are as follows: 552 (0.5%) in the column “Eligible for a PrEP referral” and 163 (0.7%) in the column “Referred to a PrEP provider.”

§ For gender, the numbers of records missing or invalid are as follows: 419 (0.4%) in the column “Eligible for a PrEP referral” and 116 (0.5%) in the column “Referred to a PrEP provider.”

Race categories include the following: “White” = Hispanic White; “Black” = Hispanic Black or African American; and “Other” = Hispanic persons of other races including Asian, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and multirace. For race, the numbers of records missing or invalid are as follows: 36,654 (32.8%) in the column “Eligible for a PrEP referral” and 7,642 (31.2%) in the column “Referred to a PrEP provider.”

** For population groups, the numbers of records missing or invalid are as follows: 1,747 (1.6%) in the column “Eligible for a PrEP referral,” and 360 (1.5%) in the column “Referred to a PrEP provider.” In addition, the numbers of records for “other” excluded from this table are as follows: 8,294 (7.4%) in the column “Eligible for a PrEP referral” and 1,112 (4.5%) in the column “Referred to a PrEP provider.”

†† Mobile settings and setting unknown are excluded.

§§ Includes Puerto Rico and the U.S. Virgin Islands.

CME / ABIM MOC / CE

HIV Preexposure Prophylaxis Awareness and Referral to Providers Among Hispanic/Latino Persons — United States, 2019

  • Authors: Shubha Rao, MPH; Mesfin S. Mulatu, PhD; Mingjing Xia, MS; Guoshen Wang, MS; Wei Song, PhD; Aba Essuon, PhD; Deesha Patel, MPH; Adanze Eke, MS; Emilio J. German, MSHSA
  • CME / ABIM MOC / CE Released: 2/8/2022
  • Valid for credit through: 2/8/2023
Start Activity

  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for public health officials, infectious disease clinicians, hematologists, internists, and other clinicians caring for Hispanic patients who may be eligible for preexposure prophylaxis (PrEP) to prevent HIV infection.

The goal of this activity is to describe PrEP awareness and referral to providers among Hispanic persons, according to a Centers for Disease Control and Prevention (CDC) analysis of 2019 National HIV Prevention Program Monitoring and Evaluation HIV testing data.

Upon completion of this activity, participants will:

  • Describe pre-exposure prophylaxis (PrEP) awareness and referral to providers among Hispanic persons, according to a Centers for Disease Control and Prevention (CDC) analysis of 2019 National HIV Prevention Program Monitoring and Evaluation HIV testing data
  • Determine factors associated with PrEP awareness and referral to providers among Hispanic persons, according to a CDC analysis of 2019 National HIV Prevention Program Monitoring and Evaluation HIV testing data
  • Identify clinical and public health implications of PrEP awareness and referral to providers among Hispanic persons, according to a CDC analysis of 2019 National HIV Prevention Program Monitoring and Evaluation HIV testing data


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Medscape policies. Others involved in the planning of this activity have no relevant financial relationships.


Faculty

  • Shubha Rao, MPH

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Shubha Rao, MPH, has disclosed no relevant financial relationships.

  • Mesfin S. Mulatu, PhD

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Mesfin S. Mulatu, PhD, has disclosed no relevant financial relationships.

  • Mingjing Xia, MS

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Mingjing Xia, MS, has disclosed no relevant financial relationships.

  • Guoshen Wang, MS

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Guoshen Wang, MS, has disclosed no relevant financial relationships.

  • Wei Song, PhD

    Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Wei Song, PhD, has disclosed no relevant financial relationships.

  • Aba Essuon, PhD

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Aba Essuon, PhD, has disclosed no relevant financial relationships.

  • Deesha Patel, MPH

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Deesha Patel, MPH, has disclosed no relevant financial relationships.

  • Adanze Eke, MS

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Adanze Eke, MS, has disclosed no relevant financial relationships.

  • Emilio J. German, MSHSA

    Division of HIV Prevention
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)
    Atlanta, Georgia

    Disclosures

    Disclosure: Emilio J. German, MSHSA, has disclosed no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Reviewer

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Stephanie Corder, ND, RN, CHCP, has disclosed no relevant financial relationships.


Accreditation Statements



In support of improving patient care, Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

    Contact This Provider

    For Nurses

  • Awarded 0.25 contact hour(s) of continuing nursing education for RNs and APNs; none of these credits is in the area of pharmacology.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read about the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or print it out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

CME / ABIM MOC / CE

HIV Preexposure Prophylaxis Awareness and Referral to Providers Among Hispanic/Latino Persons — United States, 2019

Authors: Shubha Rao, MPH; Mesfin S. Mulatu, PhD; Mingjing Xia, MS; Guoshen Wang, MS; Wei Song, PhD; Aba Essuon, PhD; Deesha Patel, MPH; Adanze Eke, MS; Emilio J. German, MSHSAFaculty and Disclosures

CME / ABIM MOC / CE Released: 2/8/2022

Valid for credit through: 2/8/2023

processing....

Introduction

Hispanic or Latino* (Hispanic) persons are disproportionately affected by HIV in the United States. In 2019, Hispanic persons accounted for 18% of the U.S. population, but for 29% of new diagnoses of HIV infection[1]. The Ending the HIV Epidemic in the U.S. (EHE) initiative aims to reduce new HIV infections by 90% by 2030[2]. Preexposure prophylaxis (PrEP), medication taken to prevent acquisition of HIV, is an effective strategy for preventing HIV infection. To examine PrEP awareness and referral to providers among Hispanic persons, CDC analyzed 2019 National HIV Prevention Program Monitoring and Evaluation HIV testing data. Approximately one quarter (27%) of Hispanic persons tested for HIV at CDC-funded sites (n = 310,954) were aware of PrEP, and 22% of those who received a negative HIV test result and were eligible for referral (111,644) were referred to PrEP providers. PrEP awareness and referrals among Hispanic persons were lower compared with those among non-Hispanic White persons. Among Hispanic persons, significant differences were found in PrEP awareness and referrals by age, gender, race, population group, geographic region, and test setting. HIV testing programs can expand PrEP services for Hispanic persons by implementing culturally and linguistically appropriate strategies that routinize PrEP education and referral, collaborating with health care and other providers, and addressing social and structural barriers.

CDC analyzed 2019 National HIV Prevention Program Monitoring and Evaluation HIV testing data submitted by 60 CDC-funded state, local, and territorial health departments§ and 29 directly funded community-based organizations to assess measures of PrEP awareness and referral to a PrEP provider.** Persons whose HIV status is negative are eligible for PrEP referral when they meet the clinical criteria for PrEP prescription based on CDC guidelines or local protocols. PrEP awareness among persons tested for HIV infection was defined by an affirmative response documented by HIV test providers to the question, “Has the client ever heard of PrEP?” Similarly, PrEP referral among persons eligible for referral was defined by an affirmative response documented by HIV test providers to the question, “Was the client given a referral to a PrEP provider?” PrEP awareness and referrals among Hispanic persons were compared with those of persons of other racial and ethnic groups. PrEP measures among Hispanic persons were also compared by age, gender, race,†† ethnicity,§§ test setting, ¶¶ U.S. Census region,*** and population groups defined by transmission risk.††† Robust Poisson regression was used to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs). This activity was reviewed and approved by CDC and conducted consistent with applicable federal law and CDC policy.§§§

During 2019 in the United States, 2,341,342 CDC-funded HIV tests were conducted. These included 546,337 (23.3%) tests conducted among Hispanic persons, 919,066 (39.3%) among non-Hispanic Black/African American (Black) persons, 658,496 (28.1%) among non-Hispanic White (White) persons, and 217,443 (9.3%) among persons of other or unspecified race. Among all tested persons with PrEP-related data, PrEP awareness was slightly higher among Hispanic persons (27.4%) than among Black persons (26.2%; PR = 1.05; 95% CI = 1.04–1.06) but lower than that among White persons (31.4%; PR = 0.87; 95% CI = 0.87–0.88) and those of other racial or ethnic groups (42.1%; PR = 0.65; 95% CI = 0.64–0.66) (Figure).

Enlarge

Figure. Preexposure prophylaxis awareness and referral to preexposure prophylaxis providers, by race and ethnicity* — United States, 2019 , §

Among Hispanic persons, awareness was higher among persons aged 25–49 years (29.9%; PR = 1.07) and lower among those aged ≥50 years (17.0%; PR = 0.60) compared with those aged 13–24 years (28.1%) (Table 1). By gender, compared with females, 14.5% of whom were aware of PrEP, awareness was highest among transgender persons (68.6%; PR = 4.74) followed by males (36.6%; PR = 2.53). Awareness was higher among Black Hispanic persons (39.3%; PR = 1.91) and persons of other races (39.3%; PR = 1.91) than among White Hispanic persons (20.6%). Compared with heterosexual Hispanic females (awareness = 17.5%), PrEP awareness was higher among gay, bisexual, and other men who have sex with men (MSM) (63.5%; PR = 3.62), persons who inject drugs (28.9%; PR = 1.65), and heterosexual males (21.5%; PR = 1.22). Awareness was higher among persons tested in non–health care settings (35.4%; PR = 1.95) than among those tested in health care settings (18.1%). By U.S. Census region, PrEP awareness was lower among Hispanic persons tested in the West (49.1%; PR = 0.87), Midwest (30.1%; PR = 0.54), South (13.4%; PR = 0.24), and U.S. territories (12.9%; PR = 0.23) than among those tested in the Northeast (56.2%).

Overall, referral to a PrEP provider was higher among Hispanic persons (22.0%) compared with non-Hispanic Black persons (20.8%; PR = 1.06; 95% CI = 1.04–1.07) but lower when compared with non-Hispanic White persons (25.9%; PR = 0.85; 95% CI = 0.84–0.86) and those of other racial/ethnic groups (25.8%; PR = 0.85; 95% CI= 0.83–0.87) (Figure).

Among Hispanic persons eligible for referral to a PrEP provider, PrEP referral was higher among Hispanic persons aged 25–49 years (22.8%; PR = 1.05) and lower among those aged ≥50 years (16.6%; PR = 0.77) compared with those aged 13–24 years (21.7%) (Table 2). By gender, referral was higher among transgender persons (30.3%; PR = 2.04) and males (25.7%; PR = 1.73) than among females (14.8%). PrEP referral was lower among Black Hispanic persons (13.4%; PR = 0.55) and Hispanic persons of other races (21.6%; PR = 0.89) than among White Hispanic persons (24.3%). PrEP referral was higher among Hispanic MSM (39.5%; PR = 2.57) and persons who inject drugs (17.2%; PR = 1.12) but lower among heterosexual males (11.7%; PR = 0.76) than heterosexual females (15.4%). By test setting, PrEP referral was lower among persons tested in non–health care settings (20.4%; PR = 0.83) than among those tested in health care settings (24.6%). By U.S. Census region, PrEP referral was higher among Hispanic persons tested in the Midwest (32.9%; PR = 2.14), South (26.9%; PR = 1.75), and West (17.8%; PR = 1.16) and lower among those tested in U.S. territories (13.4%; PR = 0.87) compared with persons tested in the Northeast (15.4%).

_____

*Hispanic persons can be of any race.

https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf

§Fifty states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and seven Metropolitan Statistical Areas or specified Metropolitan Divisions: Baltimore, Chicago, Houston, Los Angeles County, New York City, Philadelphia, and San Francisco.

PrEP awareness was assessed by HIV test providers documenting a response to the question, “Has the client ever heard of PrEP (PreExposure Prophylaxis)?” The PrEP awareness question was required from all persons testing for HIV although the response could have been collected before or after the test was performed.

_____

**Referral to PrEP providers was assessed by HIV test providers documenting a response to the question, “Was the client given a referral to a PrEP provider?” Referral was provided if the person testing negative for HIV infection met the appropriate clinical criteria for using PrEP or was determined to be eligible for a PrEP referral based on CDC guidelines or local protocol. Referral to providers in this report might include passive referral (e.g., client is provided information about the PrEP provider) as well as active referral (e.g., client is assisted with contacting and making an appointment with the PrEP provider).

_____

††Race refers to the client's self-reported classification or classifications of the biologic heritage with which they most closely identify. For this report, Hispanic persons are stratified into three race groups: Black or African American (Black), White, and other, which includes American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander persons, or those with more than one race.

§§Ethnicity refers to the client's self-report of whether they are of Hispanic or Latino origin.

¶¶For each CDC-funded test, test setting is the location where the test was administered. Health care settings are clinical settings in which both medical diagnostic and treatment services were provided (e.g., primary care clinics, community health centers, emergency departments). Non–health care settings are nonclinical settings in which neither medical diagnostic nor treatment services are provided (e.g., schools or educational facilities, faith-based facilities, and field testing sites).

***State and local health department jurisdictions were categorized into the four U.S. Census regions (Northeast, Midwest, South, and West) (https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf). Puerto Rico and the U.S. Virgin Islands were grouped into the category “U.S. territories.”

_____

†††Data on behavioral risk characteristics were reported for the last 5 years before the HIV test. Men who have sex with men (MSM) includes males who reported male-to-male sexual contact and represents gay, bisexual, and other MSM; and males who reported both male-to-male sexual contact and injection drug use. Persons who inject drugs include persons who reported injection drug use. Heterosexual males include males who reported only heterosexual contact with a female. Heterosexual females include females who reported only heterosexual contact with a male. Others include transgender persons who inject drugs, transgender persons, women who have sex with women, men or women who have sex with transgender persons, and persons with no history of sexual contact or injection drug use.

§§§45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.