National HIV Testing Day Shows That There Are Many "Tests" Ahead for Those Involved in the Fight to End the Virus—Public Health Watch

Increased testing and education, as well as assistance in financing the cost of care, are clearly needed.

The Fourth of July may be the day we acknowledge the birth of the United States of America, in 1776, but June 27 is National HIV Testing Day.

Last week, in fact, marked the 24th observance of the event, created as part of a campaign by leading HIV/AIDS awareness and advocacy groups and the US Centers for Disease Control and Prevention (CDC), among others, to—obviously—encourage people (particularly those in certain high-risk demographics) to get tested for the virus. And while the news in 2018 is mostly good, there are still some troubling statistics, particularly given the stated aim of ending the epidemic by 2030.

For example, according to the CDC, even though testing services are more accessible and affordable than they were on the first National HIV Testing Day in 1995, 1 in 7 Americans with HIV don’t even know they’re positive. Worse, of the nearly 40,000 people who were diagnosed with the virus in 2015 (the most recent year for which data is available), half had the virus 3 years or more before they were diagnosed.

And, despite the existence of National HIV Testing Day, and screening campaigns by the CDC and advocacy groups, too few people are actually taking the all-important step, at least based on the findings of a study published on June 22nd in Morbidity and Mortality Weekly Report (MMWR). Among nearly 12,000 Americans surveyed on their HIV testing histories, only 39.6% reported that they had ever been tested, and the median estimated time since their last test at the time of the survey was 1080 days or almost 3 years.

“Early diagnosis and effective treatment that suppresses HIV replication not only reduces individual morbidity and mortality but also reduces the risk for transmission to others,” the authors of the MMWR article note in their concluding remarks. “Delayed diagnosis limits the benefits of early treatment initiation to minimize immune system damage and prevent HIV transmission. HIV screening is a critical entry point to a range of HIV prevention and treatment options. For persons with ongoing risk for HIV infection, annual screening also offers the opportunity to discuss options to reduce risk, including HIV pre-exposure prophylaxis (PrEP).”

Assuming PrEP is accessible and affordable, that is. As reported by NPR on June 30, costs for Truvada, Gilead’s HIV prophylaxis combination drug, have increased 45% since it was approved by the US Food and Drug Administration in 2012. Now, a 30-day supply of the medication costs $2000, a price not all insurers are willing to pay, and one that is obviously beyond the reach of the vast majority of uninsured. In response, some city and state health departments have launched PrEP assistance programs, NPR reports.

Finally, the MMWR findings suggest that those deemed at “higher risk” for HIV aren’t taking their health seriously enough. The median estimated time since last HIV test among this group was 512 days, and nearly 40% of those at higher risk reported that they have never been tested for HIV. Results from the National HIV Behavioral Surveillance (NHBS) published on June 26 by the Journal of the American Medical Association echo these statistics. The NHBS reveals that approximately 7.5% of HIV-positive men who have sex with men and 11.6% of HIV-positive people who inject drugs were unaware of their status at the time of asking.

So, hold off on the fireworks just yet—at least when it comes to HIV testing in the United States. There’s still a lot of work to be done before next June.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care-related publications. He is the former editor of Infectious Disease Special Edition.