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June 27 Is National HIV Testing Day

June 27 is National HIV Testing Day (NHTD), an opportunity to promote HIV screening and awareness of its importance as an entry point to the continuum of care. The Centers for Disease Control and Prevention (CDC) estimates that 14% of people living with HIV do not know they are infected, but new CDC data released this week show that HIV diagnosis rates vary substantially across the country, ranging from 77% in Louisiana to 90% or higher in 5 states.

Resources

• AIDS.gov: National HIV Testing Day website
• CDC: June 27 is National HIV Testing Day
• CDC: 10 Things You Can Do for HIV Testing Day
• CDC: HIV Testing Basics
• CDC fact sheet: HIV Testing in the United States
• CDC: Get Tested National HIV and STD Testing locator
• U.S. Preventive Services Task Force HIV screening recommendations
• Twitter: #NHTD

HIV Testing in the U.S.

U.S. public health agencies recommend that all adults should be tested for HIV as part of their routine health care. In 2006 the CDC recommended that adults age 13-64 should undergo HIV screening at least once, while those at ongoing risk should be tested more frequently.

A recent National Center for Health Statistics Data Brief looked at HIV testing rates during the past year, comparing groups according to demographic characteristics and HIV risk factors.

Based on data from more than 10,000 participants in the 2011-2013 National Survey of Family Growth, 19% of adults age 15-44 -- 22% of women and 16% of men -- had been tested for HIV during the past year. Higher proportions of women, young people age 15-34, and non-Hispanic blacks had been tested in the past year compared to other population groups; 33% of black men and 45% of black women reported recent testing. Among men who had sex with men in the past year, the testing rate rose to nearly 40%, compared to 20% for men who reported sex only with women.

"Consistent with previous results, levels of HIV testing in the past year were higher for persons with certain behaviors that may increase the risk of HIV infection, including having had a same-sex partner and having higher numbers of opposite-sex sexual partners in the past year," the report authors wrote.

According to the CDC, in 2011 an estimated 1.2 million persons were living with HIV in the U.S., and of these, an estimated 86% were diagnosed, 40% were engaged in HIV medical care, 37% were prescribed antiretroviral therapy, and 30% had achieved viral suppression.

However, as described in the June 26 edition of Morbidity and Mortality Weekly Report, the proportion of HIV-positive people who know their status varies widely from state to state.

H. Irene Hall and fellow CDC researchers analyzed data from the National HIV Surveillance System to estimate the prevalence of diagnosed and undiagnosed HIV infection for the 50 states and the District of Columbia during 2008-2012.

Findings

• Among the 42 jurisdictions with numerically stable estimates, HIV prevalence in 2012 ranged from 110 per 100,000 persons in Iowa to 3936 per 100,000 in Washington, DC.
• While 5 states (Colorado, Connecticut, Delaware, Hawaii, and New York) had HIV diagnosis rates of 90% or higher -- the target set forth in the National HIV/AIDS Strategy -- the rate fell to 77% in Louisiana.
• Looking just at men who have sex with men -- a group that accounts for about 60% of all new HIV infections -- in 39 jurisdictions with stable estimates, HIV prevalence in 2012 ranged from 1600 per 100,000 persons in Delaware and Iowa to 134,400 per 100,000 persons in California.
• Among men who have sex with men, the diagnosis rate reached at least 90% in Hawaii and New York, but was again lowest in Louisiana at 75%.
• 36 jurisdictions saw increases in HIV prevalence of 5% or more, with numerically significant increases in 23 jurisdictions.
• The percentage of people with diagnosed HIV increased by at least 5% in 8 jurisdictions (Arizona, Iowa, Mississippi, Nebraska, New Mexico, North Carolina, Rhode Island, and Washington, DC), but these changes were not numerically significant.

Testing is the first step in the HIV continuum of care. Receiving medical care and effective antiretroviral treatment is important for both the health of people living with HIV -- as recently confirmed by the START trial-- and to prevent transmission to others. The report authors noted that in jurisdictions where at least 90% of people with HIV had received an HIV diagnosis by the end of 2012, HIV prevalence was stable, which they suggested "could indicate that the HIV spread has slowed."

"These data demonstrate the need for interventions and public health strategies to reduce the prevalence of undiagnosed HIV infection," the researchers wrote. "Because the percentage of persons with undiagnosed HIV varies by geographic area, efforts tailored to each area’s unique circumstances might be needed to increase the percentage of persons aware of their infection."

"Continued efforts to implement routine HIV screening in health care settings and focus on targeted testing in non-health care settings to access populations in communities with disproportionately high HIV burden, including the 10 jurisdictions with the highest number of undiagnosed infectionscomprising about 68% of all undiagnosed infections, might help further reduce undiagnosed HIV infection," they continued. "[I]mprovements are also critical in other steps of the continuum of care to reach the United Nations' goals of >90% of persons living with diagnosed HIV infection receiving ART and >90% of persons receiving ART having viral suppression by 2020, and ultimately reduce HIV transmission in the United States."

6/27/15

References

HI Hall, Q An, T Tang, et al. Prevalence of Diagnosed and Undiagnosed HIV Infection -- United States, 2008-2012.Morbidity and Mortality Weekly Report64(24):657-662. June 26, 2015.

CE Copen, A Chandra, and I Febo-Vazquez. HIV Testing in the Past Year Among the U.S. Household Population Aged 15-44: 2011-2013. National Center for Health Statistics. Data Brief #202. June 2015.