Why Routine Screening Now?
CDC estimates that 1 in 8 people in the United States living with HIV don't know they're infected. People who do not know they are infected cause half of the new HIV infections each year. It's estimated that 1 in 6 Texans aged 13 and older living with HIV have not been diagnosed. This means that 18,000 Texans may be infected with HIV, but not know it.
Disease surveillance data show that more than 1 in 4 Texans with HIV received a late diagnosis of their infection. This means they were diagnosed with AIDS within three months of their HIV diagnosis. These individuals have been living with HIV for many years and represent missed opportunities for prevention and treatment.
Late diagnoses are especially high among the Hispanic population in Texas. For Hispanics with HIV living in Texas, 32% received a late diagnosis, compared to 26% of Whites and 23% of Blacks. The disparity is even greater for men. Forty four percent of Hispanic men with HIV got an AIDS diagnosis within 12 months of their first HIV diagnosis, compared to 33% of Black men and 35% of White men.
Early diagnosis and treatment are much more effective than when HIV is diagnosed late in the course of the disease. A late diagnosis means that many Texans are infected with HIV for years without the knowledge that triggers behavior change. They are also without the treatment that could lower viral load and reduce transmission. In theory, new HIV infections could be reduced by more than 30% per year if all infected people knew their HIV status and reduced behaviors that can transmit HIV to others.
HIV prevalence is rising in Texas.
In the last five years, the number of Texans reported to be living with HIV increased by almost 19%.
- In 2014, there were about 80,073 people known to be living with HIV.
- The number of newly reported HIV infections has been stable at about 4,500 cases a year.
- The number of deaths among HIV-infected persons has remained unchanged, about 1,400 per year.
So far it appears we are holding the line on new cases of HIV, but better treatment and survival means more and more people are living with the disease. What will it take to drive down new cases?
Knowledge of disease status and linkage and retention in medical care is profoundly important. It can help prevent new infections. People with HIV must know their status. Knowledge of one’s HIV infection has a direct impact on the health and well-being of that person, their loved ones, and their community. Knowledge also provides an opportunity to halt further transmission. Once people are diagnosed with HIV they tend to take steps to protect their partners. People living with HIV are also less likely to infect others if they are on treatment that lowers the amount of virus in their systems.
In 2006, CDC issued Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Healthcare Settings. These recommendations called for HIV screening for patients ages 13 to 64 in all healthcare settings. These recommendations are intended to address the persistently high estimates of undiagnosed or late-diagnosed HIV infection. In 2013 the United States Preventive Services Task Force (USPSTF) issued recommendations that clinicians screen adolescents and adults aged 15 to 65 years for HIV infection. Younger adolescents and older adults who are at increased risk should also be screened. The USPSTF recommends that clinicians screen all pregnant women for HIV, including those who present in labor who are untested and whose HIV status is unknown. Both of these are Grade A recommendations.
Risk-based screening continues to be important, but new action must be taken to make screening more available.
For many years we pursued a strategy of risk-based targeted screening (screening based on risk factors). This remains an important commitment and we must take new action to reach those who do not know their status. HIV screening must be more widely available and acceptable.
Stigma remains an important barrier; routine screening may help overcome it.
HIV has been fraught with stigma that continues to hamper our efforts today. To reach those who will not be touched by risk-based, opt-in strategies, we must normalize HIV screening. The incorporation of routine HIV screening can help us make great strides forward in reducing the stigma that continues to surround HIV.
Routine opt-out screening for HIV must become a part of the medical care encounter.
We invite you to join us. Learn about routine HIV screening in Texas. Help us carry this message of change in our approach to HIV prevention.