OBJECTIVES: The objective of the study was to assess differences in HIV testing and HIV risk behaviors by depression status among a nationally representative sample of U.S. adults.

METHODS: We conducted a cross-sectional study using data from the 2018-2020 Behavioral Risk Factor Surveillance System (BRFSS) survey. We included respondents aged 18 years old and older with self-reported depression status. The outcomes included dichotomous measures of HIV testing and HIV risk behaviors (e.g., non-prescription injection drug use, and treatment for sexually transmitted disease). We employed multivariable logistic regression models to analyze the associations between depression and HIV testing or risk behaviors. For respondents with prior HIV testing experience, we further assessed the duration since the last HIV test because people at high risk are encouraged to receive testing at least annually for early intervention if necessary.

RESULTS: Among the 1,228,405 adults retained, people with depression had 51% higher odds of receiving HIV testing [adjusted odds ratio (AOR) (95% CI)=1.51 (1.48, 1.55); P<0.001] and 51% higher odds of involvement in HIV risk behaviors [AOR (95% CI)=1.51 (1.44, 1.58); P<0.001] compared to those without depression. When comparing the duration from the last HIV testing, people with depression had a shorter period compared to those without [median: 27.1±0.45 vs. 29.3±0.34 (months), considering all study years].

CONCLUSIONS: Depression was associated with higher odds of HIV testing and engagement in HIV risk behaviors. People with depression demonstrating higher odds of HIV risk behaviors could be at higher risk for contracting HIV. Even though people with depression also had higher odds of HIV testing, the long time periods (median>24 months) since the last HIV test still failed to meet the annual HIV testing goal recommended by the Centers for Disease Control and Prevention.