Recently the Center for Disease Control (CDC), American College of Physicians (ACP) and the United States Preventative Services Task Force (USPSTF) recommended routine HIV testing for all adults and teenagers. This is a major change from the previous testing recommendations which encouraged routine testing for at-risk individuals only. However, there are many barriers to implementation of these new recommendations. The biggest barrier, which spans all aspects of the testing procedure, is lack of awareness. In general, we need greater HIV advocacy in order to increase awareness and information about this epidemic.
Stigmas about HIV/AIDS
HIV was first discovered in the 1980s amid rising fears about this mysterious and rapidly spreading disease. Because the earliest cases were documented in gay men, the disease was first termed Gay Related Immune Deficiency or “GRID”. The term AIDS was coined in 1982, and implemented in 1984. HIV/AIDS is also associated with drug addiction, promiscuity and prostitution; all of which are sensitive and emotional topics for many people. This complicates how society perceives HIV/AIDS positive individuals. During the early 80s and 90s, HIV positive individuals were discriminated against and shunned from society, friends, and even from their own families. Today, we know so much more about HIV, including how it is caused, how it is spread, and how to manage it. It is clear that one does not have to fall into a high risk group to contract HIV. However, the fear and stigma surrounding the disease still handicaps many people from educating themselves, and getting tested. This constitutes a major barrier to the fight against HIV/AIDS propagation in the United States.
The only way to reduce the fears and stigmas associated with HIV/AIDS is to encourage open conversations about the disease to enlighten people and eliminate any biases. It will be important to break down the fear-based stigmas about HIV/AIDS and to encourage AIDS education. We also need to encourage the protection of human rights for HIV positive individuals. Unfortunately, public opinion is not an easy thing to change, but small victories are helping to make progress.
Lack of education
Many people, both clinicians and the general public alike, believe HIV is not an immediate concern. This is due to the fact that most of the general public believes they are at low or no risk. Also, most clinicians are not HIV specialists. Therefore, the majority of people do not keep up to date about the latest information regarding HIV and AIDS. This unfortunately means that most people do not even know about the new recommendations for HIV testing. This, of course, presents a huge barrier for implementing these regulations. In order for HIV testing to be effective as a preventative measure, everyone needs to be aware of the recommendations, and how to apply these recommendations to themselves.
This widespread lack of awareness of general HIV knowledge and the new testing recommendations can only be remedied by increased advocacy. There are many HIV advocacy groups such as Medwiser, which seek to educate the public about HIV and how to protect themselves. With reduced stigmas about HIV and with increased media attention on the HIV epidemic, people will begin to educate themselves. It is also important to have teachers, doctors, and peers as role models for AIDS education so that waves of understanding are created instead of clouds of fear and judgment. AIDS education will be most useful when introduced at a young age, during health and sex education classes.
There should also be specialized education programs geared towards health care providers. Clinicians are authoritative figures for patients seeking information about HIV/AIDS. They are the people who should be upholding the testing recommendations. Clinicians need to be educated on the new recommendations, the importance of HIV testing, and the rules and regulations for implementing testing. They should also be aware of the newest HIV treatments and strategies to reduce HIV transmission. Each state has its own laws about HIV testing and should therefore take the initiative to educate the clinicians in their area about these laws. The laws need to be clearly explained, and this information should be dispersed to all health care centers in the state. Many states have completely adopted the recommendations of the CDC, which helps to clear some confusion. However, not enough health care providers are aware of the new testing recommendations, procedures, and regulations. More effort is required to help spread the word.
Many health care providers have cost concerns which also poses a barrier to HIV testing. Many fear that the testing procedures will not be covered by insurance companies and think that the burden of increased HIV diagnoses will be too much for our health care systems. However, since the USPSTF has also recommended routine testing with a grade “A” rating, it is likely that insurance companies will alter their policies to cover HIV testing. Additionally, starting in 2014, under the Affordable Care Act, insurers will not be able to alter policy coverage due to a pre-existing condition. These adjustments help alleviate concerns about the cost of routine HIV testing.
In addition, cost analyses have shown that the cost of routine testing and earlier diagnosis is much more cost effective than at-risk testing and late diagnosis. Remember that the 20-25% of people who do not know they are HIV-positive account for 49% of all HIV transmissions. Early detection could reduce both of these numbers, thereby reducing the amount of people requiring treatment for HIV/AIDS.
Improving infrastructure for testing
It is important that infrastructure be improved in order to help alleviate gaps in education and financing This will help reduce stigma and improve linkage to care. Systems such as HATS, the HIV/AIDS test screening software, were developed to assist patients and providers in implementing testing on a larger scale. Similarly, technology can be used to help overcome barriers in education addressing both the need for testing while helping to reduce the stigma associated with the disease.