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HIV Testing

A Priority for
Helping End the HIV Epidemic

In many ways, HIV testing should be the cornerstone of all efforts to help end the epidemic in the United States. It is the first step in getting people diagnosed and then linked to care, and it provides an important opportunity to discuss prevention options with people at risk for HIV.1 Unfortunately, we know that from 2016 to 2017, less than 40% of people in the US had ever been tested for HIV and, in 2019, an estimated 1 in 8 people living with HIV in the US was unaware of their status.2,3

Thumbnail: HIV Testing

Everyone knowing their status is an important part of helping end the HIV epidemic. It allows people to move forward and talk to a healthcare provider about next steps.

Recommendations for HIV Testing

The Centers for Disease Control and Prevention (CDC) recommends that everyone ages 13 to 64 get tested for HIV at least once in their lifetime, and that people at increased risk for HIV get tested more often—each year or even more frequently (every 3 to 6 months, for example)—depending on their relationships and behavior.1 Among other criteria, regular HIV testing is recommended for:

  • Men who have sex with men (MSM)1
  • People who have had more than 1 sexual partner since their last HIV test1
  • Transgender people who have sex with men4,5
  • People who have had a sexually transmitted infection (STI)1
  • People who use injection drugs1
  • People whose sexual partners fall into any of these categories1

It is also important that pregnant women talk to their healthcare provider about getting tested for HIV. Testing as soon as possible in pregnancy can help expectant mothers who are HIV positive receive the care they need to prevent mother-to-child transmission of HIV.1

Many People Are Not Getting Tested for HIV

Data suggest, however, that many people are not following these HIV testing guidelines.

  • From 2016 to 2017, data showed that less than 40% of people in the US have ever been tested for HIV2
  • From 2016 to 2017, data showed that less than 30% of people in the US who were most at risk for acquiring HIV were tested in the prior year2
  • From 2016 to 2017, data showed that only 26% of people in the US recommended for annual HIV testing in 7 states with a disproportionate rural HIV burden were tested in the prior year2
  • A US survey conducted between 2006 and 2016 showed that among adults aged 18 and older who were ever tested for HIV, the median time since their last test was nearly 3 years6

In 2018, only 30% of young people aged 18 to 24 in the US reported having ever been tested for HIV compared to 55% of those aged 25 to 34, 59% of those aged 35 to 44, 49% of those aged 45 to 54, 35% of those aged 55 to 64, and 17% of those aged 65 and older.7 The CDC analyzed data from the General Social Survey between 2006 and 2016 and found that 38% of men and 41% of women in the US had ever been tested for HIV.6 The analysis revealed more information about who gets tested and how often:

  • A higher percentage of Black Americans (57%) reported having ever been tested for HIV compared to that of Hispanic/Latino Americans (47%) or White Americans (35%)6
  • Despite higher rates of HIV in the Southern US, people there were generally no more likely to report having ever been tested (42% compared to 43% in the West, 38% in the Northeast, and 33% in the Midwest)6,8
  • 71% of men in the US who had a recent male sex partner reported having ever been tested for HIV, but only 42% had been tested within the past 12 months6
  • 58% of men in the US with other recent HIV-related risk behaviors (such as multiple female sex partners) reported having ever been tested for HIV, but only 37% had been tested within the past 12 months6
  • 66% of women in the US with recent HIV-related risk behaviors reported having ever been tested for HIV, but only 46% had been tested within the past 12 months6

Barriers to HIV Testing

In the early days of HIV, there were few treatment options, and a positive test result was seen as a death sentence. Things have changed dramatically since then, and with the proper care, people can live with HIV for many years.9,10 In order to receive such care, however, people must first get tested for HIV.1 Research has shown that fear and stigma as well as perceived cost and perceived lack of risk prevent many people from seeking the HIV testing they need.11

One study published in 2019 asked men and women aged 19 to 64 living in the Southern US why they hadn’t been tested for HIV and had them rank possible reasons. Concerns about cost and insurance reimbursements were ranked highest followed by not knowing where to receive HIV care and not feeling at risk for HIV. Fear of the testing procedure and the results were also on the list. Some of the other barriers identified in the study highlight the stigma that still surrounds both HIV and HIV testing. Participants feared that HIV testing reflected poorly on them as a person, that they’d be judged by their healthcare provider, and that other people would find out about the test.11

A 2017 survey of young people aged 18 to 30 in the US found similar results. Of those surveyed, more than half (54%) had never been tested for HIV. When asked why, 67% of those not tested said they didn’t think they were at risk for HIV, and 41% said a doctor had never suggested HIV testing. Other reasons for not getting tested included feeling embarrassed, not knowing where to go, cost or privacy concerns, and fear of the test results.12

A separate US survey from 2014 to 2015 of people over the age of 18 found that many (65%) would like their physician to recommend HIV testing, and 85% said they would be “likely or very likely” to accept an HIV test if their physician offered it.13

HIV TESTING IN
THE US BY AGE, 2018

Bar Graph Showing HIV Testing in the US By Age, 2018Bar Graph Showing HIV Testing in the US By Age, 2018

Only 30% of young people IN THE US aged 18 to 24 in 2018 reported having ever been TESTED FOR HIV.

Source: AIDSVu. HIV testing by age, 2018. Deeper Look: HIV Testing. Data available through the CDC Behavioral Risk Factor Surveillance System (BRFSS).

Cost of HIV Testing

Though the perceived cost of HIV tests is often cited as a barrier, most people should be able to get tested for little or no cost.11 The Affordable Care Act requires insurance companies to cover HIV testing with no co-pay, and both Medicaid and Medicare cover some HIV testing. In addition, many community-based organizations and health departments will offer HIV testing for free or at very low cost to people who do not have insurance.1,14,15 The CDC also covers the cost of an at-home HIV testing kit.16

Opt-In vs Opt-Out Testing Policies

Since 2006, the CDC has recommended that providers in all types of healthcare settings, including primary care settings, obstetric offices, public health and community-based clinics, hospitals, urgent care clinics, and emergency departments, offer HIV testing to all patients as part of standard care.17 Under this kind of a policy, patients are told—verbally or through the forms or brochures they receive—that they will be given an HIV test unless they tell their healthcare provider they do not want to be tested. They do not need to give specific consent for the HIV test as it is considered part of the routine preventive care they are consenting to during the visit.18 This is referred to as an “opt-out” policy.17

In contrast, an “opt-in” policy asks patients deemed to be at risk if they’d like to be tested for HIV. The CDC believes that opt-in policies miss many people whose risk factors for HIV may be less obvious, such as heterosexual men and women who are unaware of their HIV risk, and those who live in non-urban, low-prevalence settings.18 Research has also found that people may underestimate their own risk for HIV, and that fear of stigma and discrimination prevents many people from getting tested when given the option.19

By testing everyone, opt-out policies can also remove some of the stigma associated with HIV testing and can help lead to earlier diagnoses and treatment.18 Data from 2011 to 2013 from one study showed that opt-out policies lead to higher rates of HIV testing than other policies.20

HIV Testing Settings

Today, people can find HIV testing across different settings. Many healthcare providers offer testing in their offices. Clinics, health departments, community-based health centers, and hospitals also offer HIV testing. HIV self-tests are also available at pharmacies and online, and some health departments and other organizations will send rapid self-tests to people’s homes at low or no cost.15

Information about where to get tested can be found here: 
https://AIDSVu.org/services/#/testing

Testing Procedures

HIV testing can be done with a saliva sample, a finger prick of blood, or a blood draw from a vein. Some HIV testing can also be done with a urine sample. Different types of HIV tests rely on different samples, and results take anywhere from 20 minutes to several days. In addition, some tests can detect HIV infection sooner after exposure than others; the time between exposure and being able to detect infection through a test is often called the “window period.”21

Different HIV Tests21

The type of HIV test a person gets is largely dependent on where they get tested, but understanding the differences may be helpful.

Type
of Test
Antibody
test
Antibody/
Antigen Test
Nucleic
Acid Test
(NAT)
Where/Why
It is Used
Most rapid tests and the only approved self-tests are antibody tests.
Antibody/antigen tests are recommended for testing done in labs, but there is also a rapid version available.
This test is used as a first screening for HIV if an individual is believed to have recently had a high-risk exposure and has early symptoms of HIV infection.
Sample Used
This test can be done using saliva, a finger prick, or blood drawn from a vein.
Lab tests must be done using blood drawn from a vein. The rapid version uses a finger prick.
NATs can be done only with blood drawn from a vein.
What It
Looks For
HIV antibodies. Antibodies are proteins produced by the immune system when it is exposed to viruses.
The p24 antigen and HIV antibodies. Antigens are molecules that stimulate the immune system. In people with HIV, an antigen called p24 is produced even before antibodies develop.
NATs look for the actual virus in a person’s blood. This test can tell not only if a person is infected with HIV, but can also determine how much virus is in their blood. This test is expensive. It is not usually used for initial diagnosis, but instead to determine viral load of people known to have HIV.
How Soon It Can
Detect HIV Infection
Antibody tests can detect HIV infection between 23 and 90 days after exposure. Tests that use blood drawn from a vein can usually detect antibodies sooner than those that use finger pricks or saliva.
Antigen/antibody tests done using blood drawn from a vein can usually detect HIV infection between 18 and 45 days after exposure. Those tests done using a finger prick can detect infection between 18 and 90 days after exposure.
NATs can usually detect the virus in a person’s blood between 10 and 33 days after exposure.
How Long
Results Take
Results of rapid antibody tests using saliva or a finger prick can be ready in 30 minutes or less. Results of antibody self-tests can be ready in 20 minutes.
Results of rapid antigen/antibody tests from a finger prick can be ready in 30 minutes or less. Results from tests using blood drawn from a vein need to be processed in a laboratory; this can take several days.
NATs using blood drawn from a vein need to be processed in a laboratory; this can take several days.
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  1. Centers for Disease Control and Prevention. Getting tested. Reviewed April 9, 2021. Accessed July 29, 2021.
    https://www.cdc.gov/hiv/basics/hiv-testing/getting-tested.html
  2. Pitasi MA, Delaney KP, Brooks JT, DiNenno EA, Johnson SD, Prejean J. HIV Testing in 50 Local Jurisdictions Accounting for the Majority of New HIV Diagnoses and Seven States with Disproportionate Occurrence of HIV in Rural Areas, 2016-2017. MMWR Morb Mortal Wkly Rep. 2019;68(25):561-567.
  3. Centers for Disease Control and Prevention. CDC fact sheet: HIV in the United States and Dependent Areas. July 2021. Accessed August 25, 2021.
    https://www.cdc.gov/hiv/pdf/statistics/overview/cdc-hiv-us-ataglance.pdf
  4. Centers for Disease Control and Prevention. National transgender HIV testing day – April 18. Reviewed April 19, 2021. Accessed July 30, 2021.
    https://www.cdc.gov/hiv/library/awareness/nthtd.html
  5. Centers for Disease Control and Prevention. HIV and transgender people. April 2021. Accessed July 30, 2021.
    https://www.cdc.gov/hiv/pdf/group/gender/transgender/cdc-hiv-transgender-factsheet.pdf
  6. Pitasi MA, Delaney KP, Oraka E, et al. Interval Since Last HIV Test for Men and Women with Recent Risk for HIV Infection – United States, 2006-2016. MMWR Morb Mortal Wkly Rep. 2018;67(24):677-681.
    https://www.cdc.gov/mmwr/volumes/67/wr/mm6724a2.htm?s_cid=mm6724a2_e
  7. AIDSVu.org. Deeper look: HIV testing. Accessed July 30, 2021.
    https://aidsvu.org/resources/deeper-look-hiv-testing/
  8. Centers for Disease Control and Prevention. HIV in the southern United States. Published September 2019. Accessed July 30, 2021.
    https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-in-the-south-issue-brief.pdf
  9. National Institute of Allergy and Infectious Diseases. HIV/AIDS. Updated June 29, 2020. Accessed July 30, 2021.
    https://www.niaid.nih.gov/diseases-conditions/hivaids
  10. National Institute of Allergy and Infectious Diseases. HIV cure. Updated March 26, 2019. Accessed July 30, 2021.
    https://www.niaid.nih.gov/diseases-conditions/hiv-cure-research
  11. Wise JM, Ott C, Azuero A, et al. Barriers to HIV testing: patient and provider perspectives in the deep south. AIDS Behav. 2019;23(4):1062-1072.
  12. Kaiser Family Foundation. 2017 national survey of young adults on HIV/AIDS: chart pack. November 30, 2017. Accessed July 30, 2021.
    https://files.kff.org/attachment/Chartpack-National-Survey-of-Young-Adults-on-HIV/AIDS
  13. Baumann KE, Hemmige V, Kallen MA, Street RL, Giordano TP, Arya M. Whether patients want it or not, physician recommendations will convince them to accept HIV testing. J Int Assoc Provid AIDS Care. 2018;17:2325957417752258.
  14. Kaiser Family Foundation. HIV testing in the United States. Published June 25, 2019. Accessed July 26, 2021.
    https://www.kff.org/hivaids/fact-sheet/hiv-testing-in-the-united-states/
  15. Centers for Disease Control and Prevention. Find an HIV test. Reviewed May 13, 2021. Accessed July 26, 2021.
    https://www.cdc.gov/hiv/basics/hiv-testing/finding-tests.html
  16. TakeMeHome. About. Accessed July 26, 2021.
    https://together.takemehome.org/about/
  17. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55(RR-14):1-17; quiz CE1-4.
  18. Centers for Disease Control and Prevention. Opt-out screening. Reviewed March 4, 2020. Accessed July 26, 2021.
    https://www.cdc.gov/hiv/clinicians/screening/opt-out.html
  19. Golub SA, Gamarel KE. The impact of anticipated HIV stigma on delays in HIV testing behaviors: findings from a community-based sample of men who have sex with men and transgender women in New York City. AIDS Patient Care STDS. 2013;27(11):621-627.
  20. Montoy JCC, Dow WH, Kaplan BC. Patient choice in opt-in, active choice, and opt-out HIV screening: randomized clinical trial. BMJ. 2016;532:h6895.
  21. Centers for Disease Control and Prevention. Types of HIV tests. Reviewed May 13, 2021. Accessed July 26, 2021.
    https://www.cdc.gov/hiv/basics/hiv-testing/test-types.html

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