Today, June 27, could be another commemorative day on the calendar, or it could mark an opportunity to permanently turn the trajectory of this country’s HIV epidemic. Today is National HIV Testing Day.
The United States has embraced United Nations’ call for comprehensive action to end the epidemic. It is a call based on the projection that if, in the next five years at least 90 percent of people living with the virus know it, if at least 90 percent of them are accessing appropriate treatment, and if the treatment is consistent and effective enough in 90 percent of them to control the virus they live with, the AIDS pandemic could end as a public health threat by 2030. Those are a lot of “ifs,” and as a nation we are not doing as well as we could at turning them into realities. The most recent CDC data indicates that while 86 percent of people with HIV know their diagnosis, 40 percent are engaged in care and only 30 percent are virally suppressed. We can do better, starting with the first step, getting HIV tested.
It’s a step that one in eight people living with HIV in the United States hasn’t taken. That adds up to more than 156,000 people in this country alone who aren’t getting the care they need to stay healthy, and who aren’t getting the treatment that will help them avoid transmitting the virus to other people. It adds up to more than 156,000 missed opportunities to reap the benefits of progress in science and policy. And without the preventive benefits of knowing one’s status and of accessing treatment, it adds up to one of the reasons that the United States continues to be home to 50,000 new HIV infections every year. We can do better.
We already are doing better than we have in the recent past. In 2011, just a half decade ago, the U.S. Centers for Disease Control and Prevention was reporting that one in five people living with HIV in this country didn’t know it. The progress we’ve made is a testament to the benefits of CDC guidelines recommending opt-out testing in healthcare facilities and the US Preventive Services Task Force recommendations that HIV screening be routine for everyone aged 18 – 64 years. And, as the number of Americans with health insurance has risen steadily since the key provisions of the Affordable Care Act took effect in early 2014 more people can get HIV testing. Today, still, however, 11 percent of Americans are without health insurance. That rate could drop significantly if all states expanded Medicaid.
But even with access to medical services, many Americans may choose to remain ignorant of their HIV status. Currently 32 states and two territories explicitly criminalize potential HIV exposure (even if no real threat of transmission exists) and failure to disclose that one has HIV. Applying only to people who have tested positive for the virus, these laws discourage people with HIV or at risk of HIV from knowing their status, while studies have consistently found they do nothing to lower rates of HIV transmission.
In addition to those laws, a number of policies serve as barriers to health services for many at the greatest risk, including undocumented immigrants, incarcerated people, and people who still live under the shadow of bias, stigma and discrimination against gay, lesbian, bisexual and transgender individuals, against people who earnincome through sex work, and against people who use drugs. We need to ensure that these key populations can access HIV testing safely and free of fear and that, if found to be infected, they are linked to care and treatment services.
When we confront and remove all of those obstacles, every day can be HIV testing day. Every day can open doors to treatment and health for people who are living with the virus, to awareness of preventive measures and peace of mind for those who are not, and to knowledge, for all of us, of what is necessary to end the pandemic. Let’s start with changing policies that feed stigma, improving access to testing and treatment, and, of course, getting tested and knowing your own status.
Dr. Carlos del Rio is chairman of the HIV Medicine Association, chairman of the Department of Global Health at the Rollins School of Public Health, and professor of medicine in the Division of Infectious Diseases at Emory University School of Medicine.