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Low testing rates concern CDC
Less than a quarter at high risk got tested in the last year

by Richard Merritt
DURHAM — Researchers at Duke University have conducted an analysis of HIV testing rates and found that individuals in higher-risk groups, such as men who have unprotected sex with men, are less likely to have been tested in the past year.

The rates of HIV testing have remained relatively low since 2000. Only a third of all Americans have ever been tested for the virus and less than a quarter of individuals in high-risk groups have reported being tested in the last year.

This is significant because those who do not know their status are believed to be responsible for over half of new HIV infections in the U.S., making the expansion of HIV testing a top priority for the Centers for Disease Control and Prevention (CDC).

“We found that high-risk groups want to get tested — but their actions don’t match up with their intentions,” said Brian Wells Pence, Ph.D., an infectious diseases epidemiologist at Duke University’s Center for Health Policy.

Individuals at a higher-risk of contracting HIV, those experiencing depression or those abusing alcohol showed a gap between their intentions of getting tested and actually getting the procedures done. Those who participate in unprotected sex or use injection drugs are at higher risk.

“Recent policy statements emphasize broadening HIV testing in the general population,” Pence said. “But such efforts should not come at the expense of trying to meet the desire for testing in higher risk groups. The results of our analysis suggest that high-risk groups know they should be tested — so significant potential may still exist to increase testing in such groups by focusing on access. Patients at alcohol and mental health treatment sites, for example, may be receptive to increased testing opportunities.”

The Duke researchers focused on a particular aspect of the survey results — the difference between the proportion of individuals reporting an intention to get an HIV test in the coming year and the proportion that had been tested in the past year.

The researchers found that overall, rates of actual testing slightly exceeded rates of planned testing — but the reverse was true among high-risk groups. Specifically, although 27 percent of those at highest risk said they wanted to be tested in the next year, only 11 percent had actually sought out a recent test, Pence said.

“Our analysis suggests that individual and structural barriers keep some individuals, and especially high-risk individuals, from translating their testing intentions into action,” Pence said. “Those who lacked a source of primary healthcare, for instance, were less likely to act on their intentions to test. The same was true of individuals who reported being depressed or abusing alcohol.”

In a finding that supports the CDC recommendation that HIV testing be included in routine medical care, the Duke team found that about 44 percent of the tests taken during the study period were prompted by encounters with the health care system, such as prenatal care visits or other routine medical appointments.

The researchers concluded that the CDC’s efforts to incorporate HIV testing in routine medical care have been successful in making testing more generally available.

The researchers also found that minority women were significantly more likely to get tested than white males.

An estimated 1.1 million Americans are infected with HIV, with about one-quarter of them unaware of their infection.

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