Download or read book The Impact of Sexual Behaviours Risk Perceptions and the Criminalization of HIV Non Disclosure on HIV Transmission Among HIV Negative and HIV Positive Men Who Have Sex With Men in Toronto written by Maya A. Kesler and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background: Men who have sex with men (MSM) continue to have disproportionately high rates of human immunodeficiency virus (HIV), even though risk factors for HIV acquisition are known and antiretroviral treatment has reduced transmission. Objectives: To characterize the sexual behaviours and risk perceptions of HIV transmission among HIV-negative and HIV-positive MSM. Methods: 150 HIV-negative and 292 HIV-positive MSM participated in the STI/HIV Co-Infection Study between September 2010 and June 2012. Participants were recruited from the Maple Leaf Medical Clinic, a primary and HIV-related care centre in Toronto. Multivariable logistic regression (MLR) models quantified the relationships between actualsexual HIV risk, HIV incidence risk index for MSM (HIRI-MSM), perceived HIV risk and willingness to take pre-exposure prophylaxis (PrEP) among HIV-negative MSM. MLR and flow chart models were used to estimate the potential impact of HIV non-disclosure laws on HIV testing rates and transmission among HIV-negative MSM, and on condom use, HIV status disclosure and proportion at risk for criminal prosecutions among HIV-positive MSM. Results: As condom use frequency with HIV-positive regular partners decreased, perceived HIV risk (Odds Ratio (OR):18.33, 95% Confidence Interval (CI):1.65-203.45) and willingness to take PrEP (OR:27.11, 95% CI:1.33-554.43) increased. Condom use frequency with casual or HIV-unknown status regular partners and the HIRI-MSM index were not associated with perceived HIV risk or PrEP willingness. The 7% (9/124) reduction in HIV testing due to fear of prosecution found in this study could increase community HIV transmission by 18.5%; the majority of transmission being driven by the unmet needs of undiagnosed HIV-positive MSM. Almost half of HIV-positive MSM were more likely to use condoms and/or disclose their HIV-positive status due to fear of prosecution and 8.6% (25/292) could be at risk for non-disclosure prosecutions given their condom use, viral load and disclosure rates. Conclusions: HIV-negative MSM using condoms less frequently with HIV-positive partners but not with HIV-unknown status or casual partners accurately gauged their sexual risk behaviour and were willing to take PrEP. HIV non-disclosure laws may incentivize safer sex practices among HIV-positive MSM; however, they may also deter HIV testing which impedes HIV prevention efforts and increases community HIV transmission .
Download or read book On the Criminalization of HIV Nondisclosure written by Bryan Eric Benner and published by . This book was released on 2021 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background: In Canada, failure to disclose HIV+ status before sex can result in incarceration and status as a registered sex offender for life. In 2012, the Supreme Court of Canada ruled that there is no legal mandate for HIV disclosure before sex if (i) a condom is used and (ii) HIV viral loads are extremely low. There is very little known about how the legal mandate for HIV disclosure might inequitably affect the health and safety of sex workers. Purpose: This study critically interrogates the interplay between the legal mandate for HIV disclosure and the routine health-conscious practices (e.g., HIV testing, condom use) of HIV-negative survival sex workers, with particular attention to inequitable health and safety outcomes. This study also qualitatively investigates the structural and social forces that mediate vulnerability to HIV infection and transmission among sex workers, their clients, and their non-commercial, intimate partners. Method: This study employed an adapted grounded theory approach to conducting and analyzing (n=9) open-ended, in-depth interviews with a convenience sample of currently working and recently exited sex workers who were clients at PEERS, an NGO offering services and support to sex workers in Victoria, Canada. Findings: The criminalization of HIV nondisclosure had no discernable influence on behavioural HIV risk factors or HIV testing. Participants lacked accurate knowledge of the legal mandate for HIV disclosure. HIV-related health literacy was low. Participants strongly supported HIV disclosure as a legal obligation - but only for exacting justice, and not for reliably offering protective health benefits. The uptake of high-risk sexual practices was driven almost exclusively by (i) extreme needs when servicing clients (e.g., drugs, childcare, money) and (ii) the rich symbolism of condomless sex in non-commercial, intimate partnerships. Participants reported differential degrees of entrenchment in the sex trade at various times in their working lives due to extreme needs. Participants emphasized the importance of ongoing HIV testing as a personal responsibility in order to monitor and maintain their sexual health. Participants identified increased uptake of HIV-related knowledge as affording the most significant protective health benefits against HIV infection. Implications: Lower levels of HIV-related health and legal literacies in the sample call for greater scrutiny of the impacts of initiatives such as 'Seek and Treat for Optimal Prevention of HIV/AIDS' (or STOP HIV/AIDS®) which target vulnerable populations across British Columba [BC]. Deeply entrenched sex workers have little recourse to exit the sex trade immediately upon receiving an HIV+ test result, especially in under-resourced social assistance milieux. Targeting this population for HIV testing facilitates the creation of a new caste of HIV+ potential criminals, despite the well-established, beneficial health outcomes at the individual and population levels from early commencement of antiretroviral treatment. Conclusion: Survival sex workers require special considerations in HIV pre-test counselling. The empowerment of sex workers can come firstly through the enhancement of HIV-related health - and legal - literacies. Full knowledge of the advantages and disadvantages of HIV testing will allow the consent for HIV testing to be truly informed. New HIV testing guidelines make BC the first province to recommend regular HIV screening for all adults. These guidelines also recommend exclusion of discussions of the criminalization of HIV nondisclosure in pre-test counselling for all patients. Re-thinking the consent for HIV testing among sex workers is crucially important for their immediate health and safety.
Download or read book Do Criminal Laws Influence HIV Risk Behavior An Empirical Trial written by Scott Burris and published by . This book was released on 2012 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: All states have criminal laws that can be used to punish sexual behaviors that pose some risk of HIV transmission; half have HIV-specific laws criminalizing sexual contact by people with HIV unless they abstain from unsafe sex, or disclose their HIV status and obtain consent from their partners. Whether these laws influence behavior is unknown. Illinois and New York exhibit contrasting legal conditions. Illinois has an HIV-specific law explicitly requiring disclosure by HIV+ persons. New York has no HIV-specific law. This study tests the null hypothesis that differences in law and beliefs about the law do not influence condom use in anal or vaginal sex. In this empirical study, 490 people at elevated risk of HIV were interviewed, 248 in Chicago and 242 in New York City. Approximately half in each state were men who have sex with men ("MSM") and half were injecting drug users ("IDUs"). Respondents were classified as MSM if they reported ever having had sex with a man, and as IDUs if they reported having injected drugs at least twice in the last three months. One-hundred sixty two subjects reported known HIV infection (Chicago 58; New York City 104). Three-hundred twenty-eight reported being HIV negative or not knowing their HIV status. Indicators of the law were 1) residence in the state, and 2) belief that it is a crime for a person with HIV to have sex with another person without disclosing his or her serostatus. Using stepwise logistic regression, we examined independent predictors of unprotected sex, adjusting for factors including age, race/ethnicity, disclosure, biological sex at birth, sexual orientation and number of partners. People who lived in a state with a criminal law explicitly regulating sexual behavior of the HIV-infected were little different in their self-reported sexual behavior from people in a state without such a law. People who believed the law required the infected to practice safer sex or disclose their status reported being just as risky in their sexual behavior as those who did not. Our data do not support the proposition that passing a law prohibiting unsafe sex or requiring disclosure of infection influences people's normative beliefs about risky sex. Most people in our study believed that it was wrong to expose others to the virus and right to disclose infection to their sexual partners. These convictions were not influenced by the respondents' beliefs about the law or whether they lived in a state with such a law or not. Because law was not significantly influencing sexual behavior, our results also undermine the claim that such laws drive people with and or at risk of HIV away from health services and interventions. We failed to refute the null hypothesis that criminal law has no influence on sexual risk behavior. Criminal law is not a clearly useful intervention for promoting disclosure by HIV+ people to their sex partners. Given concerns about possible negative effects of criminal law, such as stigmatization or reluctance to cooperate with health authorities, our findings suggest caution in deploying criminal law as a behavior change intervention for seropositives.
Download or read book Criminalized Lives written by Alexander McClelland and published by Rutgers University Press. This book was released on 2024-06-14 with total page 135 pages. Available in PDF, EPUB and Kindle. Book excerpt: Canada has been known as a hot spot for HIV criminalization where the act of not disclosing one’s HIV-positive status to sex partners has historically been regarded as a serious criminal offence. Criminalized Lives describes how this approach has disproportionately harmed the poor, Black and Indigenous people, gay men, and women in Canada. In this book, people who have been criminally accused of not disclosing their HIV-positive status, detail the many complexities of disclosure, and the violence that results from being criminalized. Accompanied by portraits from artist Eric Kostiuk Williams, the profiles examine whether the criminal legal system is really prepared to handle the nuances and ethical dilemmas faced everyday by people living with HIV. By offering personal stories of people who have faced criminalization first-hand, Alexander McClelland questions common assumptions about HIV, the role of punishment, and the violence that results from the criminal legal system’s legacy of categorizing people as either victims or perpetrators. Note: A regrettable error appears on page 22. The number 240 should be 206 when referring to the number of people prosecuted in relation to allegations of HIV nondisclosure. This will be fixed in future reprints.
Download or read book Sexual Interactions and HIV Risk written by Luc van Campenhoudt and published by Taylor & Francis. This book was released on 1997 with total page 288 pages. Available in PDF, EPUB and Kindle. Book excerpt: This work examines the theories and perspectives involved in the study of sexual risk behaviour and HIV. It provides a framework for analysis based on sexual interactions and their social context.
Download or read book Substance Use HIV Serostatus Disclosure and Sexual Risk Behavior in People Living with HIV An Event level Analysis written by Matthew Sullivan and published by . This book was released on 2018 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Objective. Sexually active people living with HIV (PLWH) face difficult decisions about disclosing their HIV status to sexual partners. Alcohol and other drug use are prevalent in medically engaged PLWH, and could impact these decision-making processes. We sought to examine the event-level relationships between substance use, HIV disclosure, and condom use in PLWH. Method. Adult PLWH were recruited from care settings in a southeastern US city. Participants reported psychosocial and health information at baseline, and reported their sexual behavior for 28 consecutive days via text message prompts. Multi-level modeling was employed to examine event-level associations between substance use, HIV disclosure, and condom use in first-time sexual encounters with HIV-/unknown status partners. Results. From a larger sample, 251 participants (85% male, 92% African American) engaged in anal or vaginal intercourse with presumed serodiscordant first-time partners on 529 days (mean=2.11 partners). Event-level substance use did not predict condom use in inconsistent condom users (p>0.05), yet heavier alcohol users used condoms less frequently on average (p=0.01). Event-level substance use negatively predicted disclosure across the 28-day study period (odds ratio=0.46; p=0.04). Disclosure was more frequent among consistent condom users than those who consistently engaged in condomless sex (p0.05). Conclusions. Results found that substance use at the time of intercourse is associated with decreased HIV disclosure in PLWH. Substance using PLWH may benefit from interventions designed to moderate substance use or enhance behavior skills for reducing HIV transmission risk when using substances.
Download or read book Sexual Health Human Rights and the Law written by World Health Organization and published by . This book was released on 2015-06-17 with total page 72 pages. Available in PDF, EPUB and Kindle. Book excerpt: This report demonstrates the relationship between sexual health, human rights and the law. Drawing from a review of public health evidence and extensive research into human rights law at international, regional and national levels, the report shows how states in different parts of the world can and do support sexual health through legal and other mechanisms that are consistent with human rights standards and their own human rights obligations.
Download or read book Contextualizing Risk written by Cherie Blair and published by . This book was released on 2021 with total page 166 pages. Available in PDF, EPUB and Kindle. Book excerpt: Men who have sex with men (MSM) are disproportionately affected by the HIV epidemic and represent 70% of incident HIV cases in the United States, despite constituting 3.9% of the population. These disparities are particularly relevant in the context of the burgeoning stimulant use epidemic, as stimulant use is associated with increased HIV and sexually transmitted infection (STI) prevalence among MSM. Given these contexts, this dissertation consists of three studies that explored the impacts of stimulant use on HIV/STI transmission dynamics among a diverse cohort of MSM in Los Angeles, California. Study one examined the relative contributions of methamphetamine use, depression, and sexual risk behavior on rectal STIs using path analysis. Study two consisted of a latent class analysis to determine risk behaviors associated with patterns of sexualized stimulant and alcohol use. Study three used machine learning techniques, specifically least absolute shrinkage and selection operator (lasso) and elastic net, for variable selection to determine characteristics associated with increased stimulant use and whether these factors differed in relation to HIV status. This dissertation demonstrated that the factors surrounding stimulant use and HIV/STI transmission dynamics are both nuanced and complex. Our findings reinforced the known associations between syndemic health conditions, such as depression, unstable housing, polysubstance use, and transactional sex, with stimulant use and sexual risk behaviors. However, our results highlight that the factors and contexts surrounding stimulant use and sexual risk behaviors likely differ between MSM subpopulations. For example, Black/Latinx MSM who engaged in stimulant use were more likely to experience syndemic health conditions (e.g., STIs, depressive symptoms) than their Black/Latinx counterparts who did not engage in sexualized stimulant use. Similar differences in stimulant use patterns were observed based on HIV status. Among MSM living with HIV, increased stimulant use correlated highly with reported co-substance use whereas sexual risk behaviors and sexual partnership contexts were correlated with increased stimulant use among HIV-negative MSM. This dissertation demonstrates that the contexts and factors which contribute to stimulant use patterns likely differ between MSM subpopulations and suggest that these differences should be accounted for in the design of HIV prevention and treatment interventions.
Download or read book The connection between HIV risk and unsafe sex between men written by ROMEO LEE and published by GRIN Verlag. This book was released on 2017-10-02 with total page 33 pages. Available in PDF, EPUB and Kindle. Book excerpt: Academic Paper from the year 2017 in the subject Health - Public Health, De La Salle University (College of Liberal Arts), language: English, abstract: This report reviews published research-based data on the prevalence of anal intercourse without using condoms (AIWC) among men having sex with men (MSM) samples and the characteristics of MSM having AIWC. The number of MSM in various parts of the world and who are contracting sexually transmitted infections (STI), including human immunodeficiency virus infection, is increasing. Risk-reduction interventions need more nuanced information to further understand how AIWC, the main driver of the growth in the STI prevalence among MSM populations, can be better addressed. Overall, the findings indicate that there are large numbers of MSM samples reported to have engaged in AIWC (range: 12%-72%). There are a variety of characteristics found to be statistically significantly related with AIWC, many of which are related with the general life aspects of MSM. Risk-reduction interventions need to do more in reaching out to the MSM populations by broadening the focus, substance and impact of their efforts.
Download or read book Risk and Protective Factors Related to HIV risk Behavior written by Jason C. Forney and published by . This book was released on 2008 with total page 188 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Sexual Assault in Canada written by Elizabeth A. Sheehy and published by University of Ottawa Press. This book was released on 2012-09-29 with total page 833 pages. Available in PDF, EPUB and Kindle. Book excerpt: Sexual Assault in Canada is the first English-language book in almost two decades to assess the state of sexual assault law and legal practice in Canada. Gathering together feminist scholars, lawyers, activists and policy-makers, it presents a picture of the difficult issues that Canadian women face when reporting and prosecuting sexual violence. The volume addresses many themes including the systematic undermining of women who have been sexually assaulted, the experiences of marginalized women, and the role of women’s activism. It explores sexual assault in various contexts, including professional sports, the doctor–patient relationship, and residential schools. And it highlights the influence of certain players in the reporting and litigation of sexual violence, including health care providers, social workers, police, lawyers and judges. Sexual Assault in Canada provides both a multi-faceted assessment of the progress of feminist reforms to Canadian sexual assault law and practice, and articulates a myriad of new ideas, proposed changes to law, and inspired activist strategies. This book was created to celebrate the tenth anniversary of Jane Doe’s remarkable legal victory against the Toronto police for sex discrimination in the policing of rape and for negligence in failing to warn her of a serial rapist. The case made legal history and motivated a new generation of feminist activists. This book honours her pioneering work by reflecting on how law, legal practice and activism have evolved over the past decade and where feminist research and reform should lead in the years to come.
Download or read book Minority Stress and HIV Risk Behavior Among HIV positive Bisexual Black Men with Histories of Childhood Sexual Abuse written by Kimberly Anne Kisler and published by . This book was released on 2013 with total page 220 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the United States, significant disparities in HIV/AIDS exist among Black men who have sex with men (MSM). For instance, in 2006, Black MSM comprised 63% of new HIV infections among Black men, and 35% of new HIV infections among all MSM (Centers for Disease Control and Prevention [CDC], 2010a). Further, Black MSM were the only risk group in the United States to experience statistically significant increases in new HIV infections between 2006 and 2009 (CDC, 2012a). To address such disparities, HIV prevention efforts that focus on reducing the stress associated with sociocultural factors, such as experiences and perceptions of racism and homophobia, have been proposed. Utilizing the minority stress model and the theory of Intersectionality as guiding theoretical frameworks, this study examined: the relationship between indicators of minority stress (events of racial/ethnic discrimination, internalized racism, and internalized homophobia) and HIV risk behavior; whether psychological distress and/or social support moderate this relationship; and whether a culturally congruent intervention was efficacious in reducing perceptions of internalized racism and internalized homophobia, and frequency of HIV risk behavior among a sample of HIV-positive non-gay identifying Black men who have sex with men and women and who have histories of childhood sexual abuse. The full sample included 117 men who were administered a baseline survey, as well as a sub-sample of 88 men who were randomized into either the Enhanced Sexual Health Intervention for Men (ES-HIM) intervention or Health Promotion control condition as part of the ES-HIM Project. The original randomized control trial took place between 2007 and 2011. Only perception of internalized racism was found to have a direct association with HIV risk behavior in this sample, though this relationship was negative meaning increased racial pride predicted more HIV risk behavior. The full model that included all indicators of minority stress, childhood sexual abuse, and social support explained HIV risk behavior better than each indicator of minority stress on its own. This supported the additive perspective of the theory of Intersectionality, but not the primary perspective of this theory. The interactionist perspective was also tested between internalized racism and internalized homophobia, but findings did not result in support for this perspective. The role of psychological distress was inconclusive. While ample evidence supported the removal of psychological distress in order to test a direct relationship between indicators of minority stress and HIV risk behavior, some support for moderation was found. Social support showed clear indication of a moderating effect between two indicators of minority stress and HIV risk behavior when controlling for other covariates. Further, the level of social support and the indicator of minority stress contributed to the overall effect of social support on HIV risk behavior. In terms of intervention effects, internalized racism did not decrease over the four time points for either the group as a whole (n=88), or by intervention condition. Internalized homophobia, however, significantly diminished over the four time points for the group as a whole, but no differences between the ES-HIM intervention and Health Promotion control condition were found. Finally, frequency of HIV risk behavior (i.e., intercourse without a condom) also decreased from baseline to post-intervention assessment for the group as a whole, but no intervention effects were found. Indicators of minority stress, namely internalized racism and internalized homophobia, appear to play an important role in the HIV risk behavior of this population. However, the relationship is nuanced among this highly marginalized sample. Finally, while the ES-HIM intervention was unsuccessful in effecting changes in internalized racism, internalized homophobia, and frequency of HIV risk behavior over time, significant reductions in internalized homophobia and HIV risk behavior for the group as a whole were achieved.
Download or read book Sexual Interactions and HIV Risk written by Mitchell Cohen and published by Taylor & Francis. This book was released on 2003-12-16 with total page 282 pages. Available in PDF, EPUB and Kindle. Book excerpt: How sexual risk is negotiated betwen partners is an area of considerable theoretical interest, with the dominant models of analysis focusing on individual decisions to engage in sexual behaviour and relying on "rational" decision-making. This work, based on the findings from work coordinated by the Centre d'Etudes Sociologiques in Brussels, offers a social critique of the theories and perspectives which have currently been brought to bear in the study of sexual risk behaviour and HIV. Leading European researchers offer a conceptual framework for analysis based on sexual interactions and their social context. The practical relevance of new perspectives on sexual behaviour in the context of HIV/AIDS prevention is also discussed.
Download or read book Association of HIV Stigma and Sexual Behavior written by Carol Leah Holmes and published by . This book was released on 2010 with total page 322 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Sexual Risk Behaviors Among Men who Have Sex with Men written by Heather Alisa Pines and published by . This book was released on 2013 with total page 98 pages. Available in PDF, EPUB and Kindle. Book excerpt: Recent clinical trial results suggest that new HIV prevention interventions, such as pre-exposure prophylaxis and treatment as prevention, protect against HIV infection. However, several barriers to widespread implementation of these interventions have been identified. In response to some of these challenges, many argue that new HIV prevention interventions should only be delivered to high-risk populations within integrated HIV prevention programs that consist of biomedical, behavioral, and structural interventions. In the United States, men who have sex with men (MSM) remain the most heavily HIV affected population, and thus will likely be the target of such programs. This dissertation aims to inform the development of MSM-specific HIV prevention programs by providing a better understanding of the situations in which new prevention strategies could have the greatest impact within this population. More specifically, this dissertation examines longitudinal patterns of sexual risk behavior, socio-demographic and behavioral factors associated with partnership type and serostatus, and individual-level and sexual event-level predictors of condom use during receptive anal intercourse among MSM. Chapter 2 is based on data from the Multicenter AIDS Cohort Study (MACS) and demonstrates that HIV-negative MSM exhibit distinct sexual risk trajectories and that those following a high risk trajectory exhibit "seasons of risk" over time. Chapter 3 also uses data from the MACS to show that the reported number of male sexual partners is associated with partnership type and serostatus and that the magnitude and direction of this relationship differs by HIV status. Chapter 4 is based on longitudinal data from a cohort of racially/ethnically diverse HIV-negative MSM followed for one year in Los Angeles, and demonstrates that the effect of methamphetamine use on condom use during receptive anal intercourse at the sexual event-level is greatest in the context of non-main partnerships. Findings from this dissertation expand the current understanding of risk behaviors among MSM, and have implications for the development of integrated HIV prevention programs for MSM in the United States.
Download or read book AIDS Sexual Behavior and Intravenous Drug Use written by National Research Council and published by National Academies Press. This book was released on 1989-02-01 with total page 606 pages. Available in PDF, EPUB and Kindle. Book excerpt: The AIDS virus is spread by human behaviors enacted in a variety of social situations. In order to prevent further infection, we need to know more about these behaviors. This volume explores what is known about the number of people infected, risk-associated behaviors, facilitation of behavioral change, and barriers to more effective prevention efforts.
Download or read book Criminal Penalties for Non disclosure of HIV positive Status written by Daniel Lynn Wise and published by . This book was released on 2008 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: This research examined whether laws criminalizing non-disclosure of HIV-positive status affects HIV testing rates and incidence. An interrupted time-series design was used. Totals of monthly HIV tests, confidential and anonymous tests, incidence, and tests with reported risk were collected from state health departments with (i.e., New Jersey, California, and Virginia) and without (I.e., North Carolina, Oregon, and Texas) criminal laws. ARIMA Models had low R-bar squared values, yet graphically fit the data well, and yielded white noise residuals. Significant abrupt and permanent changes were found to coincide with enactment of the laws in New Jersey, with total monthly tests and total monthly confidential tests increasing, and monthly tests for persons not reporting risk factors decreasing on the month of enactment of the law. Incidence decreased at 6 month delay from enactment of the New Jersey law. In Virginia, total monthly tests increased at the time of the enactment of the law. There were no changes in testing of incidence detected within California. In an effort to discover and control for the possible confounds of historical events, data were aggregated by month across non-intervention states. The non-intervention variable was a consistent and highly significant control variable for the intervention time-series analyses. While it is possible that these laws stimulated testing, improved effectiveness of treatment and the subsequent dissemination of information regarding the positive effect of treatment on health outcomes may be the likely reason for any overall increases in HIV testing that we have detected in this study. We found no change in testing among people at-risk. Upon learning of the law, a subset of the population (in this case those testing but not reporting risk behaviors) may have decided against future testing. While it is possible that the law led to a decrease in participation in risk behavior, thus leading to a decrease in incidence, it is also possible that the decrease in incidence found in New Jersey indicates an overall reduction in testing among persons at-risk for HIV. Uniformity of data collection, management, and accessibility across states would enable more comprehensive examinations of effects of policy on HIV testing.
