Universal HIV testing is hardly universal

In a dramatic policy shift six years ago, federal health officials began recommending that all Americans ages 13 to 64 be tested for HIV. They worried that the virus was spreading to people who might not consider themselves at risk, and they hoped to cut transmission by the tens of thousands of people who didn't know they had the virus. At the University of Minnesota, three researchers have studied the "mainstreaming" of HIV testing and were invited to present their findings at the International AIDS Conference in Washington this week. Graduate student Ryan Moltz discussed the findings.

Q How have federal recommendations for HIV testing have changed over time?

A When the Centers for Disease Control [and Prevention] first began making recommendations, they were targeted toward specific, high-risk groups. These included men who have sex with men, people who trade sex for drugs or money and injection drug users. Then the recommendations were broadened to include other people, like hospital patients and pregnant women, and [finally] all people ages 13-64.

Q Why?

A [One reason is that] the people at risk have changed over time. Now HIV/AIDS is one of the leading killers, for example, of young black women.

Q What effect have the changes had?

A In the early years, men got tested more often than women, but now women get tested more often than men. Women, blacks, Hispanics, immigrants and the poor -- people who are disadvantaged in terms of access to medical care -- are all more likely to be tested now. There has [also] been an increase in the number of people getting tested because of medical reasons -- because they have an illness or medical problem, or as part of routine checkups or surgeries.

A No, the majority of people receiving medical care are not being tested. That suggests there's not a lot of implementation. It's not even a majority. One thing I should point out is that pregnant women have been, I would say, the biggest success story. In 1991, the proportion of pregnant women who had had an HIV test in the past year was 21 percent. In 1997, that number had gone up to 60 percent.

Q Your data suggest that people who considered themselves medium- to high-risk were more likely to get tested before 2006 than since then. Is that a sign of complacency?

A That could be. The turning point in terms of HIV becoming a life sentence rather than a death sentence was around 1996, when the [drug] cocktail became available. Since then, we're seeing a steady decline in testing over time [for some groups]. Complacency could be playing a role.

Q What other barriers exist?

A In many states, health insurance companies will only cover an HIV test if it is related to your primary diagnosis.