June 27 is National HIV Testing Day. On this day, we unite with federal and tribal partners across the country to raise awareness about the importance of HIV testing and early diagnosis of HIV. The Indian Health Service recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of their routine health care. People at higher risk should get tested more often.
The IHS, a primary partner in Ending the HIV Epidemic: A Plan for America , encourages early diagnosis and early entry into treatment, two major factors in the elimination of the disease. Increasing the number of people who are aware of their HIV status is a critical objective in reaching this goal, so that people living with HIV can be linked to care and receive treatment that reduces illness and transmission of the virus.
When a person receives a diagnosis early and carefully follows their HIV treatment plan, they can achieve an undetectable level of HIV in their blood, which can mean a full and healthy life. Getting to an undetectable level of HIV also prevents sexual transmission of the virus to another person. To promote this message, we use the term U=U, or undetectable equals untransmittable.
An analysis from the Centers for Disease Control and Prevention shows that about 80% of new HIV infections in the U.S. in 2016 were transmitted from the nearly 40% of people with HIV who either did not know they had HIV, or who had been diagnosed but were not receiving HIV care. This underscores the impact of undiagnosed and untreated HIV and also the critical need to expand HIV testing and treatment in the U.S.
In 2013, IHS and many tribal and urban Indian health care facilities followed CDC recommendations in order to meet testing goals. IHS also broke down barriers to testing by allowing other members of the medical team to order HIV tests, rather than centralizing routine screening on just a few health care providers. Finally, IHS added a ‘reminder’ to the electronic health record that prompts a clinician to recommend an HIV test for patients who had not previously been tested. These and other local changes in policy and practice contributed to a steady increase in the proportion of patients screened for HIV in IHS, tribal and urban Indian health facilities.
Early detection and linkage to care may be helping. Recent CDC data shows a 30% decline in HIV deaths among American Indians and Alaska Natives from 2014-2018. The new data indicates that the rate of deaths from HIV among American Indians and Alaska Natives is now below that of whites in the United States. While national statistics can often undercount American Indians and Alaska Natives in the data, this decline is an encouraging trend.
However, challenges remain. All IHS facilities, especially larger hospitals, tend to see a plateau in HIV testing numbers. Testing in emergency rooms and urgent care facilities is possible, but requires staffing and other resources that often are not available. Due to the COVID-19 pandemic, IHS is looking toward HIV self-testing, or home testing. This not only reduces the stigma in testing, but allows for social distancing and reduces the number of non-urgent patients in a clinic at any given time.
We look forward to taking our success in HIV screening even further as we move forward.