HIV Screening and Access to Care: Exploring Barriers and Facilitators to Expanded HIV Testing

摘要

The HIV epidemic remains a major disease burden in the United States, with approximately 56,300 new infections occurring each year (CDC, 2008a). Knowledge of HIV status and receipt of timely care can help to prevent HIV transmission and improve clinical outcomes. Yet, of the 1.1 million people in the United States living with HIV/AIDS, approximately 21 percent are unaware that they are infected with the disease (Campsmith et al., 2010). The White House Office of National AIDS Policy (ONAP) has developed a National HIV/AIDS Strategy (NHAS) to reduce new HIV infections, increase access to care and improve health outcomes for individuals living with HIV, and reduce HIV-related health disparities in the United States (ONAP, 2010). To help inform the implementation of the NHAS, an Institute of Medicine committee hosted a public workshop and gathered data to assess the extent to which federal and state laws and policies, and private health insurance policies, pose a barrier to expanded HIV testing. The committee identified barriers to HIV testing that included state legal requirements for HIV testing; discordant federal HIV testing recommendations; public and private health insurance policies; policies inhibiting use of rapid HIV tests; and policies and practices in corrections settings. In addition, the committee identified the need for more programs and policies to promote clinician education and training and reduce constraints on practice environments, as well as reduce HIV stigma and discrimination, as barriers to expanded HIV testing. The committee identified several strategies to increase HIV testing and identification of HIV-infected individuals as well. The research reviewed by the committee indicates that opt-out HIV testing, where an individual is told that testing will e performed unless he or she declines, may facilitate HIV testing, although there is still ebate about the ethics of opt-out HIV testing.