David Malebranche, M.D., Associate Professor, Emory University School of Medicine, Atlanta
Late HIV testing among black Americans is a contributor to the current HIV racial disparity in America. Many believe that a lack of testing is the cause, but in fact, black Americans have the highest HIV testing rates among any racial/ethnic group in the country. The issue is not "if" we get HIV testing or not, but rather "when" this testing takes place.
Similar to other chronic disease issues such as high blood pressure, cancer screening, diabetes and heart disease, HIV testing is a byproduct of poor overall health care access. In many situations, we are much more likely to use an emergency room as our primary care provider. And this is mostly a reflection of larger societal issues such as poverty, lack of health insurance, transportation, institutional stigma, work schedules, and racism and cultural incompetency among providers.
These factors may influence our behaviors and how we choose to prioritize our health, receive medical or public health messages, and follow recommendations by medical providers.
Yes, "to test or not to test" for HIV is subject to a number of different, very specific factors such as fear of disease, discrimination and community stigma, not to mention the individual-level impact a positive HIV test may have on personal decisions of disclosure and sexual behavior with partners. But if the foundation of health care that is available to us is shaky, talking about HIV testing will be a moot point if we can't even access and have positive experiences in the settings that often provide these testing services.