A new report released by the U.S. Centers for Disease Control and Prevention (CDC) confirms there are still distressingly high numbers of HIV-positive people who don't know they're living with the virus, but things are improving. Nationwide, approximately one in eight Americans living with HIV don't know they have the virus.
In the June 26 issue of Morbidity and Mortality Weekly Report (MMWR), the CDC focused on HIV in the lead up to National HIV Testing Day on June 27. "HIV testing is the essential entry point to a continuum of prevention, health care, and social services," noted the agency, "that improve the quality of life and the length of survival for persons with HIV."
With that in mind, the National HIV/AIDS Strategy seeks to increase "to 90 percent the proportion of people living with HIV who are aware of their status." The CDC reported that, as of 2012, many states have already met this goal, including Hawaii, New York, Connecticut, Delaware and Colorado.
The lowest ranked state in the nation is Louisiana, where the CDC estimated that only 77% of HIV-positive people know their status. Many other Southern states rank low in status awareness, including: Georgia at 81%; Mississippi at 84%; Arkansas, South Carolina and Texas, each with only 83% of HIV-positive residents aware of their status.
While the trend seems to imply that so-called blue states have higher proportions of HIV-positive people who know their status, this is not a hard-and-fast rule based upon the data: Illinois, New Jersey and Massachusetts all have not met the 90% goal for status knowledge.
Those who don't know their status account for "nearly one-third of new infections in the U.S.," Irene Hall, Ph.D., M.P.H., told TheBody.com. She's chief of the CDC's HIV Incidence and Case Surveillance Branch. Despite this, Hall said that "it's encouraging that, generally, the majority of infections are diagnosed and once people know they have HIV, they take steps to prevent transmission to partners."
Hall added that "testing is critical to the nation's prevention strategy." After all, it's "the only way to identify the approximately one in eight Americans living with HIV who do not know they are infected."
Across the U.S., local organizations are working to increase advocacy for and uptake of HIV testing. One such organization is GALAEI. Described as a "queer Latin@ social justice organization," GALAEI provides social services -- including HIV testing -- with a human, not merely clinical, touch.
"GALAEI HIV testing counselors take a lot of time and compassion to really ensure that they are having thoughtful conversations with anybody who comes in," explained GALAEI's Executive Director Elicia Gonzales, and those counselors "recognize that a lot of people who walk through the door are afraid of their status." That's why GALAEI strives to maintain a reputation surrounding commonsense compassion.
"Knowing full well that somebody is going to be met with somebody who is non-judgmental, caring, compassionate and able to link people into medical care if necessary helps alleviate some of those fears" of testing, Gonzales insisted.
Pennsylvania, where GALAEI is located, ranks near the middle in the CDC's rankings, with an estimated 86% of HIV-positive individuals aware of their status. In Philadelphia, approximately 20,000 people live with HIV.
Hall said that decreases in undiagnosed HIV infection in recent years "may be due to intensified testing efforts. Additionally, the CDC has pursued a 'High-Impact Prevention' approach to ensure resources are directed to activities that will have the greatest impact on reducing HIV among those most affected in the areas with the greatest need." The high-impact approach includes "public awareness campaigns to increase testing and encourage people with HIV to seek ongoing care," as well as unconventional methods of reaching untested or not recently tested individuals.
"Continued efforts to implement routine HIV screening in health care settings and focus on targeted testing in non-health care settings," explained the CDC, "might help further reduce undiagnosed HIV infection."
One innovative way to increase testing is underway in Philadelphia, and GALAEI is part of it.
"One of the things that we're excited about is continuing to normalize HIV testing," Gonzales explained. "We're doing a partnership with Philly AIDS Thrift to make HIV testing available in a retail space to reach more people." Proceeds from the Philly AIDS Thrift benefit HIV/AIDS treatment and research, and the space is now a cultural landmark in Philadelphia.
Along with GALAEI, several other area HIV service organizations are taking part in the retail collaboration to bring HIV testing into those non-health-care settings cited by the CDC.
Gonzales echoed Hall's sentiment that testing is paramount: "Once people know their status, they decrease in likelihood of being able to transmit the virus to other people and are able to be connected to appropriate medical care the earlier they know their status."
Of particular importance, noted the CDC, is ramping up efforts in jurisdictions where the proportion of people unknowingly living with HIV is particularly high, including California, Florida, Georgia, Louisiana, Maryland, New Jersey, New York, Ohio and Texas. Together, those states account for 68% of all HIV-positive Americans who don't know they're infected.
Knowing one's HIV status is, of course, a prerequisite for starting treatment. While only 40% of Americans with HIV are under medical care, 37% of those living with HIV are estimated to be taking antiretroviral therapy. And the CDC reported that the overwhelming majority of HIV-positive people on antiretroviral therapy maintain viral suppression.
In other words, HIV testing saves lives. And, according to the CDC, the statistics show evidence of progress in identifying those who are living with HIV through testing.
Josh Kruger is an award-winning writer and commentator in Philadelphia. His work often focuses on HIV/AIDS, cultural stigmas and social problems. You can follow him on Twitter @jawshkruger.