Less than 40% of adults in the USA have ever tested for HIV

04 July 2019

Baseline HIV testing data reveals sub-optimal testing rates among those living in the most heavily burdened areas of the USA.

New York subway scene.

Just 38.9% of people living in the United States of America (US) have ever tested for HIV reports the US Centers for Disease Control and Prevention (CDC) in a study published on National HIV Testing Day last week (27 June).

In a new analysis of HIV testing rates in the US published in the Morbidity and Mortality Weekly Report, the CDC also reports marginally higher testing rates in the 50 local jurisdictions where most of the country’s HIV diagnoses originate, with around 46.9% of people ever reporting testing for HIV. But in the seven US states with substantial rural HIV burden, just 35.5% of the population have ever tested for HIV.  

The findings provide critical baseline data for the new Ending the HIV Epidemic initiative, which was launched earlier in 2019 and aims to reduce new HIV infections in the country by 75% by 2025 and by 90% by 2030 by directing new funds and expertise to communities most affected.

The first phase of the initiative is geographically focussed on the areas with the greatest burden of HIV, before wider roll-out in phases two and three.

Phase one targets the 50 jurisdictions (48 counties, Washington D.C. and San Juan, Puerto Rico) where the most HIV infections occurred in 2016 and 2017, and seven states with a disproportionate incidence of HIV in rural areas. That is, states with at least 75 reported HIV diagnoses in rural areas that accounted for more than 10% of all diagnoses in the state. All seven states are in the South and include Alabama, Arkansas, Kentucky, Mississippi, Oklahoma and South Carolina.

A major goal of the initiative is HIV testing and the identification of people living with HIV who are unaware of their status. This follows the release of data back in April revealing that the vast majority (about 80%) of new HIV infections in the US in 2016 were transmitted from the nearly 40% of people with HIV who either did not know they had the virus, or who had received a diagnosis but were not receiving HIV care.

Data was analysed from the Behavioural Risk Factor Surveillance System (BRFSS) 2016 and 2017, a yearly national telephone survey among the adult non-institutionalised US population.

The survey asked if respondents had ever tested for HIV outside of a blood donation, and the date of their last test if they had said “yes”. Respondents were also asked if any of the following high-risk behaviours applied to them: injected drugs that were not prescribed, received treatment for a sexually transmitted infection (STI), exchanged money or drugs for sex, had anal sex without a condom, or had four or more sex partners. Those who answered “yes” to this question were considered to have reported recent HIV risk.

Among 15,701 (3.2%) persons with reported recent HIV risk for whom at least annual HIV retesting is recommended, 64.8% were ever tested for HIV and 29.2% were tested in the past year. In the 50 jurisdictions, testing rates among those most-at-risk were higher than in the seven states (34.4% vs. 26.2%). Within the seven states, testing was even more disproportionate with 18.4% of those at-risk people residing in rural areas testing in the last year compared to 29.0% of those residing in urban areas.

Testing rates varied significantly between states and jurisdictions. For example, the percentage tested in the past year (independent of reported recent HIV risk) ranged from 8.1% in Alameda County, California, to 31.3% in Bronx County, New York. This data highlights the need for locally-specific information to inform programmes to increase uptake of HIV testing in these areas.

The CDC note that novel approaches should be explored, including integrating and routinising HIV screening within a broader scope of healthcare settings, including sexual health services. The scale-up of partner notification services and other strategies should also be considered, and exploring mobile and social networking interventions and promoting pharmacist-led screening, in addition to other innovations.

Photo credit:
iStock/Alena Kravchenko. Photos are used for illustrative purposes only. They do not imply health status of any individual depicted.

Written by Caitlin Mahon

Content Specialist - HIV & Sexual Health