ORIGINAL PAPER HIV Testing Behaviors Among Undocumented Central American Immigrant Women in Houston, Texas Jane R. Montealegre • Jan M. Risser • Beatrice J. Selwyn • Keith Sabin • Sheryl A. McCurdy Published online: 2 October 2011 Ó Springer Science+Business Media, LLC 2011 Abstract This paper describes HIV testing behaviors among undocumented Central American immigrant women living in Houston, Texas, USA. Respondent driven sam- pling was used to recruit participants for an HIV behavioral survey. HIV testing items included lifetime history of testing, date and location of the most recent test, and reason for testing. Multivariate logistic regression was used to assess the demographic, behavioral, and structural charac- teristics associated with testing. The lifetime prevalence of HIV testing was 67%. Half of those who tested did so within the past 2 years and almost 80% received their most recent test in a healthcare setting. The primary reason for testing was pregnancy. Lifetime testing was associated with being from Honduras, having over a sixth grade education, having a regular healthcare provider, and having knowledge of available healthcare resources. Our results suggest that expanding access to healthcare services may increase the prevalence of HIV testing in this population. Keywords HIV testing Á Central Americans Á Immigrants Á Healthcare access and utilization Á Respondent driven sampling Introduction Latinos in the United States are disproportionately affected by the HIV epidemic, with a rate of new infections almost three times higher than that of non-Hispanic Whites. Although Latinos constitute 16% of the US population [1], they accounted for 19% of new HIV diagnoses in 2009 [2]. Over half of these cases were among Latino immigrants, who rep- resent 37% of the Latino population [3]. ‘Latino immigrants’ is a broad category that includes a multitude of regionally distinct subpopulations, of which Mexicans comprise the largest group (63%), followed by Caribbean Islanders (15.5%), Central Americans (7.9%), and South Americans (5.5%) [1]. Despite cultural and sociopolitical differences, Latino immigrants are often conceptualized as a homogenous group in health surveys. Such aggregation obscures important differences in regard to HIV risk factors, diagnosis, and sur- vival [4], making it difficult to target effective HIV prevention efforts to subgroups at greatest risk. Among Latino immigrants, Central Americans are one of the subgroups at greatest risk for HIV infection. Central Americans comprise less than 8% of the Latino immigrant population [1], but accounted for at least 10.8% of HIV cases among Latino immigrants in 2009 [2]. In addition, the rate of new infections, which has stabilized for Latinos as a whole, appears to be increasing among Central Americans. Between 2003 and 2006, the estimated number of incident HIV cases among Central American immigrants grew by an annual rate of 18.6% for males and 24.6% for females [4]. However, during the same period of time, the J. R. Montealegre (&) Á J. M. Risser Division of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, 1200 Herman Pressler Dr., RAS-336, Houston, TX 77030, USA e-mail: jane.e.richards@uth.tmc.edu B. J. Selwyn Division of Management, Policy, and Community Health, The University of Texas School of Public Health, Houston, TX, USA K. Sabin Vietnam Country Office, World Health Organization, Hanoi, Vietnam S. A. McCurdy Division of Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, Houston, TX, USA 123 J Immigrant Minority Health (2012) 14:116–123 DOI 10.1007/s10903-011-9534-x