Rates of HIV testing in the United States have remained constant since 2000, with some one-third of all Americans ever having been screened for the virus that causes AIDS.But less than 25 percent of those at high risk of infection -- such as people who have unprotected sex or are intravenous drug users -- have been tested within the past year, making it tougher to contain the epidemic, Duke University researchers report.
That gap involving high-risk individuals can be bridged through outreach programs and making HIV testing part of routine health exams, the researchers suggested.
"We found that groups that would be considered at higher risk for HIV expressed the greatest desire to get tested, and yet those groups also had the greatest gap betweentheir desire to get tested and their actual intention to get tested," said lead researcher Brian Wells Pence, an infectious diseases epidemiologist at Duke University's Center for Health Policy.
An estimated 1.1 million Americans are infected with HIV, and about 25 percent of them don't know they carry the virus, according to the U.S. Centers for Disease Control and Prevention.
"Our best estimate is that those 25 percent who don't know that they are infected are responsible for more than half of new infections, because they don't know to take preventative measures," Pence said.
"There are barriers that may affect high-risk groups," he continued, citing such potential obstacles as access to health care, the stigma that still surrounds HIV, and questions about the benefits of treatment.
"Expanding testing to help individuals know their status is a really critical element of addressing the HIV epidemic in this country," Pence said.
The findings were published in the Oct. 22 online edition of Archives of Internal Medicine.
For the study, Pence's team analyzed health surveys of 146,868 Americans and found that people at high risk for HIV tended to say they wanted to be tested but didn't follow through. Twenty-seven percent of those at highest risk said they wanted to be tested within the next year, but only 11 percent had actually had a recent test.
The researchers also found that about 44 percent of the tests taken came during regular patient visits, such as prenatal care visits or other routine medical appointments. This finding supports the belief that incorporating HIV testing into routine medical care helps make testing more available, the researchers said.
David Paltiel, an associate professor of public health at the Yale School of Public Health, agrees that HIV testing should be a part of general medical care. "It's true that we aren't testing enough people," he said. "The high risk groups have really bad follow-up, really bad linkage to care, really bad access to health care.
"Even these at-risk groups come into contact with a primary health care setting, and making it a routine part of care is the answer," he said.
Paltiel admits there are legal, political and financial problems to be overcome before HIV testing becomes routine.
Philip Alcabes, an associate professor in the School of Health Sciences at Hunter College in New York City, thinks any policy for HIV testing needs to balance privacy issues with the desire to find infected people in order to treat them.
"Making testing available in some routine way makes some sense if your goal is to find more cases and get treatment to people," Alcabes said. "But there are people who are very concerned about people knowing they have HIV. That's a reasonable concern that needs to be respected. There are people who don't want their names on lists."
SOURCES: Brian Wells Pence, Ph.D., infectious diseases epidemiologist, Duke University Center for Health Policy, Durham, N.C.; Philip Alcabes, Ph.D., associate professor, School of Health Sciences, Hunter College/City University of New York, New York City; A. David Paltiel, Ph.D., associate professor of public health, Yale School of Public Health, New Haven, Conn.; Oct. 22, 2007, Archives of Internal Medicine, online
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