Why Aren't More Americans Getting Screened For HIV?
When Dr. Lisa Fitzpatrick sees patients for an HIV test, they are often afraid of coming in, she says.
"I have quite a few people who come in and tell me that they waited to get tested because they didn't want to find out they had AIDS," said Fitzpatrick, a professor of medicine at Howard University and director HIV services at D.C. based hospital United Medical Center.
"The first thing I say is 'You're not going to die of AIDS. You're here, you are seeking treatment. If you catch HIV early enough, you don't have to develop AIDS,' " added Fitzpatrick, who also runs an HIV training program for healthcare providers in Washington, D.C.
Indeed, since the first federal announcement regarding Acquired Immune Deficiency Syndrome 30 years ago, antiretroviral therapy has made it possible to delay progression from HIV infection to AIDS, significantly prolonging patients' lives.
"We have halted and begun to reverse the epidemic," a recent UNAIDS global report stated. "Fewer people are becoming infected with HIV and fewer people are dying from AIDS."
But one area where progress has somewhat stalled is in testing.
According to early Centers for Disease Control estimates released today, 39.5 percent of American adults age 18 and older have received an HIV test at some point in their lives. That is up from a decade ago -- only 32.1 percent had in 2000 -- but it still falls dramatically short of the CDC's recommendation that everyone between the age of 13 and 64 undergo routine screening for HIV.
"I've been thinking, at the 30th [anniversary], about where we were and where we've come from, and it's striking in terms of great advancements," said Dr. Patrick Sullivan, an associate professor of epidemiology at the Rollins School of Public Health at Emory University. "But one of the problems we still have is a very basic one: We've had a test for HIV since 1985, and yet we still haven't taken full advantage of that tool."
Estimates suggest that one-in-five people living with an HIV infection does not know it. And between 2001 and 2007, one third of people diagnosed with HIV had developed AIDS within the next 12 months -- in spite of the fact that the benefits of testing and early treatment are widely known. Finding out their status so late keeping them from getting key antiretroviral therapy as soon as possible.
Left untreated, most people develop AIDS within 10 years of an HIV infection. Research has also shown that people who are unaware of their infection are three-and-a-half times more likely to transmit HIV.
Conversely, the CDC estimates that a 25-year-old who is diagnosed with HIV after seeking out testing and subsequently receives high-quality care will live 39 additional years.
There are numerous reasons why people fail to get tested. The biggest, Fitzpatrick says, is fear. People are worried about getting a diagnosis they feel will change their lives irreparably.
Healthcare providers may play a role, too. Fitzpatrick said that insurance companies often don't cover the cost of tests, and many healthcare providers still think of AIDS being a "gay, white male disease." Because of this, they don't necessarily think to screen patients who fall outside of that group.
The CDC estimates that men who have sex with men account for more than half of all new HIV infections in the U.S. every year, but Fitzpatrick stressed that HIV affects people of all walks of life. Twenty-six percent of those living with HIV in the U.S. are women, according to the Henry J. Kaiser Family Foundation. Among racial and ethnic groups, blacks account for more than 45 percent of new infections each year, according to the CDC.
Another reason why people often do not get screened is that they are uncomfortable asking their provider for the test.
"Part of the goal is to de-stigmatize testing," Sullivan said. "If I go in to my provider, I may feel that in asking for the test, I'm implying that I have some risks -- and some risks in our culture are stigmatized. Conversely, physicians may not want to offend patients. All the way around, there is this baggage associated with an offer or an ask for an HIV test."
One way both experts say this can be accomplished is by simply making sure that HIV screening is built into the script of regular health service checkups, so when a person goes in to have regular blood work done, in addition to checking for things like blood sugar levels and cholesterol, their practitioner is also screening for HIV.
Awareness campaigns have been launched, too: Next Monday, June 27, is National HIV Testing Day.
"People need to know that this is all preventable, and we don't need to see new cases," Fitzpatrick said. "With diagnosis, it's a treatable disease. No one has to get AIDS."