June 27 is National HIV Testing Day
Margo Kerrigan, M.P.H., Area Director
Indian Health Service California Area Office
June 2007 - National HIV Testing Day (NHTD) is sponsored by the National Association of People with AIDS (NAPWA), to encourage at-risk individuals to receive voluntary HIV testing and counseling. The Centers for Disease Control (CDC) estimates that more than 1 million Americans are living with HIV and that one-fourth of them are unaware of their HIV status.
Rates of HIV infection and AIDS have been increasing within the American Indian and Alaska Native (AI/AN) populations. The number of AIDS cases among AI/ANs nationally has increased from 322 in 1991 to 2,996 in 2004. California accounts for a disproportionate share of HIV/AIDS cases, both among the general population, and among AI/ANs in particular. Although California is home to approximately 12% of the total AI/AN population, statistics through 1997 show that the state accounted for 25% of all AIDS cases among AI/AN people. In Los Angeles County the rate of American Indian and Alaska Native persons living with AIDS is 301 cases per 100,000 people in 2006, a rate higher than all other racial and ethnic groups except African Americans.
New Testing Recommendations
The CDC has recently issued a recommendation for routine HIV testing for all patients (ages 13-64) in health care settings. For women who plan to become pregnant, testing is particularly important. If a woman is infected with HIV, medical care and certain drugs given during pregnancy can lower the chance of passing HIV to her baby. In 2005 the U.S. Preventive Services Task Force issued a recommendation calling for all pregnant women, not just those identified as at risk for contracting HIV, to be screened for the infection. The Institute of Medicine (IOM), the American College of Obstetricians and Gynecologists (ACOG) and the CDC all recommend universal HIV testing during pregnancy, with patient notification, as a routine component of prenatal care.
Getting an HIV test is a very personal decision. If you have taken part in activities that have put you at risk, you should consider getting an HIV test. According to the CDC, the following are behaviors that increase your chances of contracting HIV:
- Injecting drugs or steroids, and sharing needles or syringes with others.
- Unprotected vaginal, anal, or oral sex with men who have sex with men, with multiple partners, and/or with anonymous partners.
- Exchanging sex for drugs or money.
- Having hepatitis, tuberculosis, or a sexually transmitted disease (STD) like syphilis.
- Having unprotected sex with anyone who has engaged in the above behaviors.
If you have had sex with someone whose history of sex partners and/or drug use is unknown to you, or if you or your partner has had many sex partners, then you also have a higher risk of being infected with HIV.
An HIV test should be taken three to six months after the last time you may have been at risk. Most HIV tests measure the antibodies your body makes against HIV. It takes time for the body's immune system to produce enough antibodies for the test to detect. Most people will develop detectable antibodies within 2 to 8 weeks but some may take longer. Any test taken within the first 3 months of possible exposure should be repeated after the initial three month period has passed, in case of a false-negative result. Since you can be infected with HIV and look and feel healthy for years, the only way to know for sure if you are infected is by taking the HIV antibody test. In most areas, HIV testing can be done confidentially or even anonymously.
If you do learn you have HIV, you can receive medical treatment, and learn how to protect yourself and others. Because there are many new drugs and treatments available, people are living longer and healthier lives with HIV and AIDS.
Government Performance and Results Act (GPRA)
The Indian Health Service has a GPRA measure for Prenatal HIV screening. This measure calculates the percentage of pregnant women within the active clinical population who have received an HIV test within the previous year. IHS has made significant progress on this measure since it was introduced in FY 2005. In FY 2005, the national rate was 54%, in FY 2006 the rate was 65%, and as of the third quarter of FY 2007, the national rate is 75%. In California Area, the FY 2006 rate was 34%, and the third quarter 2007 rate is 49%. The FY 2007 GPRA target is to maintain the FY 2006 national screening rate of 65%.
For more information:
1-800-CDC-INFO (1-800- 232-4636)
Patients who test positive for HIV should be referred for treatment. In California, there is an HIV/AIDS Hotline at 1-800-367-2437 (AIDS) for HIV referral and consultation resources including experts of prenatal HIV treatment in your local area. Facilities should also create a list of local resources, if available, for HIV/AIDS referrals.
HIV clinical information is also available for healthcare providers through the National HIV/AIDS Clinician's Consultation Warmline at (800) 933-3413.
The Perinatal Hotline, a national HIV consultation and referral service is also available through the University of California, San Francisco at San Francisco General Hospital at (888) 448-8765. The Perinatal Hotline provides healthcare providers 24-hour advice from HIV experts on indications and interpretations of HIV testing, as well as consultation on treating HIV-infected pregnant women and their infants.
The Indian Health Service has issued guidance for providers regarding prenatal HIV testing, including information on the "opt-out" testing option: http://www.ihs.gov/cio/crs/crs_performance_improvement_toolbox.asp click on: "IHS Prenatal HIV Screening and Consent Procedures" under the section Screening Tools and Guidelines for GPRA Measures.
1. American Indian AIDS Council and National Native American AIDS Prevention Center
2. Los Angeles County Department of Health Services, HIV Epidemiology Program, www.lapublichealth.org/hiv, HIV/AIDS Semi-Annual Surveillance Summary, issued July 2006, cases reported as of June 30, 2006.