Fewer Than 4 in 10 Adults Have Ever Had an HIV Test: The Baseline for Ending the Epidemic

Visual summary. CDC

Since 2006, CDC has recommended that everyone be screened for HIV at least once in health care settings, and that people at increased risk be rescreened at least every year — but those recommendations haven't been fully carried out. The Ending the HIV Epidemic initiative aims to cut new infections by 90% from 2020 to 2030, and a key goal is finding everyone with HIV as soon as possible after infection.

The initiative starts in 57 jurisdictions:

• 50 local jurisdictions — 48 counties, the District of Columbia and San Juan, Puerto Rico — where most new HIV diagnoses in 2016 and 2017 were concentrated;
• seven states with a disproportionate share of HIV in rural areas (at least 75 rural diagnoses, making up at least 10% of the state's total): Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma and South Carolina.

CDC used the Behavioral Risk Factor Surveillance System (BRFSS) telephone survey for 2016–2017 to set a baseline.

Who has been tested

• Across the 50 local jurisdictions, ever-testing ranged from 36.5% in Maricopa County, Arizona, to 70.7% in the District of Columbia; testing in the past year, from 8.1% in Alameda County, California, to 31.3% in Bronx County, New York.
• People at recent risk — 15,701 respondents (3.2%) who reported injecting drugs, being treated for a sexually transmitted disease, exchanging sex for money or drugs, anal sex without a condom, or four or more partners in the past year: 64.8% had ever been tested, and only 29.2% in the past year — far short of the 100% recommended. Past-year testing among them was 34.3% in the 50 jurisdictions and 26.2% in the seven states, and just 18.4% in those states' rural areas against 29.0% in their urban ones.

Testing tracks diagnoses

Places with higher HIV diagnosis rates generally had higher testing (correlation r = 0.71), and most of the 50 local jurisdictions had both higher testing and higher diagnosis rates than the seven states. The converse holds too: testing was low where diagnoses were low — and lowest in rural areas of the seven states.

Adults ever tested for HIV, and HIV diagnosis rates among people 13 and older, in the jurisdictions of the Ending the HIV Epidemic initiative, 2016–2017. CDC

Closing the gap

Testing needs local, novel strategies to reach people who have never been tested:

• making HIV screening routine in health care;
• combining it with sexual health screening;
• expanding partner notification and reaching people's social and sexual networks, including through mobile apps;
• pharmacist-led testing and testing in settings such as urgent care;
• mass distribution of HIV self-tests.

Early diagnosis and effective treatment protect people's immune systems and health and reduce transmission; late diagnosis loses those benefits. For people at ongoing risk, annual screening is also a chance to discuss preexposure prophylaxis (PrEP). BRFSS is likely the only yearly survey big enough to track progress jurisdiction by jurisdiction.

Limits

Too few respondents reported recent risk to report them by jurisdiction; answers may be biased; response rates were low (medians of 47.1% in 2016 and 45.9% in 2017); the risk measure missed some behaviors, such as condomless sex with a partner who has HIV; testing covered adults 18 and older while diagnosis rates covered people 13 and older; and data from 2016–2017 give only a delayed picture of testing as of 2019.

Sources

Based on Pitasi MA, Delaney KP, Brooks JT, DiNenno EA, Johnson SD, Prejean J, "HIV Testing in 50 Local Jurisdictions Accounting for the Majority of New HIV Diagnoses and Seven States with Disproportionate Occurrence of HIV in Rural Areas, 2016–2017," MMWR volume 68, number 25, Centers for Disease Control and Prevention; a work of the United States government in the public domain.