Personalized risk assessments during Human Immunodeficiency Virus (HIV) testing are an integral component of HIV prevention counseling, an individual-level behavior change intervention to reduce the spread of HIV. Aggregated data from risk assessments are used to track behaviors in the testing population, evaluate federally-funded Counseling, Testing and Referral (CTR) programs, and inform prevention programs and allocation of resources. Unfortunately, risks disclosed during HIV test counseling may not be accurate, with stigmatizing behaviors underreported during face-to-face assessments. To understand the limitations of the CTR risk data and guide interventions to improve the validity of the risk assessment, we conducted a mixed methods study in young men in North Carolina (NC). We linked two statewide HIV databases that contain individual-level data on young men newly diagnosed with HIV in NC, comparing client-reported gender of sex partners at the time of testing to those reported during post-diagnosis partner notification (n=641). Of the 212 men who told their HIV test counselor that they had only had female sexual partner(s) in their lifetime, 62 (29.2%) provided contact information for male sex partner(s) during partner notification. Of the 25 men who reported no lifetime sex partners during test counseling, 22 (88.0%) provided partner notification information for sex partners in the last year. We then interviewed young men accessing HIV testing services in a southeastern United States city. Based on data collected via an Audio and Computer Self-Administered Interview (n=203), over 30% of young men reported that they were not accurate during the risk assessment. Participants reported numerous interpersonal barriers to accuracy during the risk assessment. During qualitative interviews (n=25), many participants revealed that they did not understand the purpose of the risk assessment nor perceive an individual benefit to complete risk behavior disclosure. Findings from this study suggest that the risk assessment completed during HIV test counseling may be incomplete which has implications for both the efficacy of individual prevention counseling and aggregate behavioral statistics. Modifications to the risk assessment process, including better explaining the role of the risk assessment in prevention counseling and using alternate assessment methods, may increase the validity of the data
