The CDC has estimated that about 40,000 people become infected with HIV each year (CDC, 2007) and approximately 38-44% of all adults in the U.S. has been tested at least once for HIV infection (CDC, 2004).  However, it has been estimated that about a quarter of individuals living with HIV are unaware of their HIV status.  That’s about 250,000 – 300,000 people who do not know that they are living with HIV and, thus, are not able to access health-promoting services. 

In honor of AIDS Education Month and National HIV Testing Day on Wednesday, June 27, this month the CHDB focuses on HIV testing in Southeastern Pennsylvania (SEPA).  This article uses data from the 2006 SEPA Household Health Survey to describe and compare populations that have been tested for HIV in the past year and populations that have never been tested for HIV.

THE CHANGING FACE OF HIV TESTING

HIV testing protocols may be changing in the U.S., a change ushered in by the Centers for Disease Control’s (CDC) release of their new HIV testing guidelines in September 2006.  These sometimes controversial new recommendations target health-care settings and include: HIV screening for all patients 13-64 in all health-care settings; screening persons “at-risk” at least once per year; minimizing specific consent procedures in favor of general consent for medical care; reducing pre-test counseling; and inclusion of HIV screening in the routine panel of prenatal screening tests for all pregnant women.  The SEPA Household Health Survey is able to track changing trends in HIV testing to provide a baseline picture of HIV testing in the region the summer of 2006 (before the recommendations were officially released).  The following article presents 2006 data on HIV testing among adults in Southeastern Pennsylvania.

HIV TESTING WITHIN THE PREVIOUS YEAR IN SEPA, 2006

In 2006, approximately 17.5% of adults, ages 18 years and older, received an HIV test in the previous year.  This represents approximately 500,000 adults in Southeastern Pennsylvania.  In addition, 6.4% reported receiving an HIV test within the previous 1-2 years, and 18.8% say they received a test two or more years before.  The proportion of SEPA adults reporting an HIV test in the previous year has remained fairly stable – at about 17-18% – since the year 2000 (Figure 1).

In total, about 43% of adults in SEPA in 2006 report that they have ever been tested for HIV, a percentage comparable (though on the higher end) of national estimates for HIV testing prevalence.  Of those who have ever been tested, about 6% report not knowing the results of their most recent HIV test, representing about 70,000 individuals in SEPA.

BY COUNTY
The 2006 county-level breakdown of those who have received an HIV test in the previous year follows a pattern similar to previous years.  In Bucks, Chester, and Montgomery Counties, the proportion of adults tested for HIV in the previous year remains around 11% (10.7%, 11.0%, and 11.5%, respectively).  In Delaware County, approximately 14.7% of adults were tested in the previous year (as compared to 13.9% in 2004).  In Philadelphia there was a slight increase in the proportion of adults receiving an HIV test in the past year: in 2006, 26.1% of adults (or about 500,000) were tested in the past year, as compared to 23.9% in 2004 (representing about 490,000 adults). 

BY AGE GROUP, GENDER, AND RACE/ETHNICITY
As might be expected, the proportion of SEPA adults having been tested for HIV in the previous declines steadily as age increases.  Among 18-39 year olds, about 3 in 10 (30.5%) have been tested for HIV in the previous year, representing about 310,000 individuals.  In contrast, about half that proportion of 40-49 year olds (16.7%) were tested in the previous year, followed by only 1 in 10 adults ages 50-59 (10.3%), about 5.8% of adults 60-74 and only 4.0% of adults ages 75 and older.  This pattern has not changed since 2000.

SEPA women and men received HIV testing in the previous year in approximately equal proportions, with only a slightly higher percentage of women testing in the past year than men (18.2% versus 16.6%).  Greater proportions of Black and Latino adults (35.4% and 29.8%, respectively) received HIV testing in the previous year as compared to white adults (10.6%). 

BY INSURANCE STATUS AND HEALTH CARE ACCESS
A greater proportion of adults (ages 18-64) without insurance received HIV testing in the previous year than adults who have insurance (26.9% versus 19.5%).  The new CDC guidelines place a focus on routine testing as part of general healthcare, which may have differential impacts depending on how often and where people access health care.  The majority of adults (ages 18 and older) in SEPA (about 90%) report that they have a regular source for their health care.  A slightly lower proportion of those with a regular source of care were tested in the previous year than those without a regular source of care (17.2% vs. 19.8%, respectively).  However, regardless of whether or not they had a regular source of care, adults who visited a doctor or health care professional (in any setting) within the previous year were more likely to have been tested for HIV in the previous year (18.5%) than those had last been to a doctor more than 1 year ago (11.3%).

NEVER BEEN TESTED FOR HIV?

Similar to the trends in HIV testing in the previous year, the proportion of SEPA adults who have never been tested for HIV has remained steady since 2000.  In 2006, about 57% of all adults 18 and older had never been tested for HIV – representing about 1.6 million adults in SEPA.  Among the insured, about half of adults 18-64 (51.5%) have never been tested for HIV, while the uninsured proportion of those never tested is lower at 42.7%.  The proportion of adults who have never been tested for HIV increases with increasing age, such that 37.2% of adults 18-39 have never been tested for HIV, while 91.4% of adults 75 and up have never been tested for HIV.  This pattern has also decreased only slightly since 2000 when 42.9% of 18-39 year olds had never been tested for HIV and 92.3% of adults 75 and up had never been tested. 

SUMMARY

Given that approximately 40,000 people may be infected with HIV each year, and that an estimate quarter of individuals living with HIV do not know their status, it is crucial to continue to track the use of HIV testing services in our region.  In addition the CDC’s new HIV testing guidelines released last September may begin to increase the proportion of adults who are tested for HIV at standard medical care visits, which could change the demographic profile of the population that is tested for HIV, and may also increase the proportion of individuals who know their HIV status.  The CHDB will continue to monitor self-reports of HIV testing in our region as one important indicator of the role that HIV is playing in the Southeastern Pennsylvania population.

For more information about the findings in this article please contact Community Health Data Base staff member Allegra Gordon at agordon@phmc.org.