STATEMENT: National HIV Testing Day
Today is the 12th National HIV Testing Day. This annual campaign, led by the National Association of People with AIDS, urges us to recognize and act on one of the AIDS epidemics great truths: What we dont know can kill us. (Click here to find a testing site near you.) The U.S. Centers for Disease Control and Prevention estimates that from a quarter to a third of the estimated 1.2 million Americans living with HIV today dont know they are infected. While broad race-specific data is not available, targeted studies suggest this is yet another challenge that disproportionately impacts African Americans. In one CDC study, nine out of 10 Black gay and bisexual men who tested positive didnt know they were infected. The CDC, citing studies that show people who know they are HIV positive are likely to protect their sex and drug-using partners, has launched an aggressive HIV-testing campaign. In last week's edition of the agency's weekly national-health report, CDC announced that it distributed 790,310 rapid-test kits to 230 organizations in 37 states between late 2003 and the end of 2005. Nearly 400,000 HIV tests were conducted with those kits, leading to the discovery of 4,650 previously hidden infections. Meanwhile, in Washington, D.C. -- where 82 percent of those living with HIV are Black -- local health officials have launched a massive campaign to get every resident aged 14 to 84 tested. The city plans to distribute 80,000 rapid-test kits to care providers and agencies serving people particularly at-risk for HIV by year's end. The Institute applauds these efforts to get more people into testing and, thereby, into healthier lives. However, as public health rightly ramps up testing outreach, it must do so with forethought, understanding that in many Black communities HIV remains a highly stigmatized disease. That means it is not nearly enough just to tell someone they are positive; testing must remain closely coupled with counseling so that people both know what it means to be positive or negative and get the help they need to live healthily with that knowledge. The CDC's pending revisions to its HIV-testing guidelines are a cause of concern for Black America, because they limit our ability to get the most out of testing. The guidelines, released for public comment in March, have the laudable goal of integrating HIV testing into regular medical care. They wisely urge care providers to offer HIV tests to all patients aged 13 to 64. But they also dangerously loosen the procedures for obtaining a patient's consent to be tested by getting rid of the need for written authorization. And while the new guidelines continue to stress the importance of counseling, they no longer require that counseling be linked to testing. HIV literacy remains disturbingly low in many Black communities. Stigma remains depressingly high at least in part as a result of that information gap. As we push for more people to learn their status, we must not simultaneously abandon our commitment to education and support that has proven crucial in the past. As important as getting tested for HIV is, a test alone is not prevention. When a patient gives active consent and discusses the details of HIV at the time a test is given, that person is more likely to understand what the results mean and more likely to take important steps toward learning to live with the virus, including changing sexual and drug-using behavior and seeking treatment. Communities that now have fluency and understanding of HIV owe it in part to the information they gained while accessing services in healthcare settings; those facing today's epidemic need and deserve the same help. Additionally, experience worldwide has proven testing cannot succeed without access to treatment. In recent years, our already anemic commitment to providing treatment for all has further waned. Medicaid is withering from lack of resources and a dearth of ideas for meaningful reform. Uninsured people with AIDS linger on waiting lists for medications throughout the country. And free or subsidized-cost care providers nationwide report desperate resource shortages. Whether it be counseling or treatment, when we encourage more people to learn their status, we must also ensure they are able to do something with the knowledge they gain. HIV testing is about accountability and responsibility; these are critical components in the fight against HIV/AIDS, for both individuals and governments.