INTRODUCTION: HIV remains a significant public health concern in the United States, with women of reproductive age facing unique social and structural barriers to care. While overall incidence has decreased, Black and Hispanic women continue to be disproportionately affected compared to White women.

AIM: This study aimed to identify racial and ethnic disparities in HIV testing among women aged 18-49 and to evaluate the role of health insurance status as an enabling factor for testing behaviors while controlling for the other factors.

METHODS: A cross-sectional analysis was conducted using the data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS). The analyzed subsample of women who answered the question about HIV testing and had the information about the other studied predictors included 67,387 individuals. Simple and multiple logistic regression models, using both unadjusted as well as survey-weighted approaches, were employed to determine associations between HIV testing status and selected predisposing and enabling factors defined by Andersen’s Behavioral Model.

RESULTS: Approximately 52.27% of the respondents reported ever being tested for HIV. Weighted multivariable analysis revealed that Non-Hispanic Black women (OR: 2.270 [2.041; 2.525]) and Hispanic women (OR: 1.233 [1.123; 1.353]) had significantly higher estimated odds of testing compared to Non-Hispanic White women. From the same weighted multivariate analysis health insurance status was a critical predictor with uninsured women having significantly lower estimated odds of testing (OR: 0.800 [0.705; 0.908]) even after adjusting for race/ethnicity, income, education, age, marital status, and region. The results for unadjusted analysis were in agreement with the adjusted analysis.

DISCUSSION: The findings support that, while racial and ethnic disparities in HIV testing persist, health insurance serves as one of the major enabling factors associated with higher estimated odds of HIV screening. Strategies to improve health equity should focus on broadening insurance access. These measures may include prioritizing Medicaid expansion and providing low-cost preventive services to address structural barriers to care, among others.