People at Risk for HIV Weren’t Getting Tested Every Year, 2006–2016

Since 2006, CDC has recommended routine HIV screening for everyone aged 13–64 and at least yearly rescreening for people at higher risk. Early diagnosis and effective treatment protect a person's health and reduce transmission — but national data show many people at higher risk aren't screened every year, and diagnoses are often delayed.

Who should be screened yearly

The 2006 recommendation called for annual testing of people who:

• inject drugs, and their sex partners;
• exchange sex for money or drugs;
• are sex partners of people with HIV;
• are sexually active gay, bisexual and other men who have sex with men (MSM) — reaffirmed in 2017 after a review found yearly screening of MSM could significantly reduce new infections;
• are heterosexual and have had — or whose partners have had — more than one partner since their last test.

The study

CDC analyzed 2006–2016 data from the General Social Survey, a household survey of U.S. adults that, unusually, asks about both HIV testing and HIV risk behaviors. The analysis covered 11,688 respondents. People with recent risk (in the past 12 months) were:

1. men who had a male sex partner;
2. other men with multiple female partners, injection drug use or paid sex;
3. women with multiple partners, injection drug use or paid sex.

Findings

• Ever testing was highest among people aged 25–34 (54.4%) and 35–44 (55.1%), Black adults (57.4%) and those with recent risk.
• The shortest intervals were among 18- to 24-year-olds (332 days), Black adults (534), people with household incomes under $35,000 (767) and those with recent risk.
• Among people with recent risk, the median interval exceeded a year in every survey year, and the share ever tested ranged from 60.0% to 66.7% — essentially no improvement over the decade.
• At-risk women tested more recently than at-risk men, likely thanks to prenatal screening.
• Fewer than half of every at-risk group had tested in the past year.

These results match other data: national surveillance found a median of two years or more from infection to diagnosis in every risk group, and a behavioral survey found 71% of MSM but only 41% of heterosexual men and women had tested in the past year.

Limitations

1. Too few people reported specific risks (such as injecting drugs) to track trends by individual risk group.
2. Self-reports may be affected by social desirability and recall, possibly overstating testing.
3. A household survey likely under-samples people who inject drugs or are homeless.
4. If people who declined to answer were at higher risk and tested less, the true interval may be longer.

What would help

Annual screening is also a chance to discuss ways to lower risk, including PrEP (pre-exposure prophylaxis). To make repeat screening routine:

• build HIV screening into standard clinical practice — through institutional policy, electronic health record prompts and staff education;
• expand screening outside clinics, through social network strategies, couples testing and counseling and home testing;
• develop new approaches for people with ongoing risk.

Sources

Based on Pitasi MA, Delaney KP, Oraka E, et al., "Interval Since Last HIV Test for Men and Women with Recent Risk for HIV Infection — United States, 2006–2016," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.