Human immunodeficiency disease (HIV) remains an epidemic in the US despite continual progress in awareness, testing and treatment of the disease over the past several decades. As of 2019, the US Centres for Disease Control and Prevention (CDC) estimated that more than one million people in the US were infected with HIV. Of these people, only 87% were aware of their diagnosis.
A recent clinical report by Hsu and colleagues from the American Journal of Pediatrics estimated that HIV infection was undiagnosed in 45% of people aged 13–24 years living with HIV. Undiagnosed HIV-positive people account for an estimated 38% of HIV transmissions, while those who are aware of their diagnosis but do not receive HIV care account for an additional 43% of viral transmissions.
In 2006, considering the consistently high prevalence of HIV and documented missed opportunities for testing, the CDC recommended routine, annual HIV testing among all sexually active individuals older than 13 years in the US. As National HIV Testing Day approaches on 27 June, it is important that practitioners, teachers and marketing campaigns aim to increase the number of people engaging in HIV testing, with a focus on youth. GlobalData epidemiologists forecast that the diagnosed prevalent cases of HIV will increase over the next five years due to the increased diagnosis of HIV that will result from the promotion of annual HIV testing of the youth population, which still remains underdiagnosed.
Hsu and colleagues reviewed epidemiological data and found that most sexually active youth in the US do not believe they are at risk of contracting HIV, and consequently have never been tested. At present, there are several barriers that reduce engagement in HIV testing among youth. Adolescents have reported concerns about confidentiality, access to testing, and limited availability of easier oral testing methods (which are used to test for other sexually transmitted diseases) as concerns surrounding HIV testing.
The CDC has emphasised the importance of universal, non-targeted HIV testing to prevent stigma towards high-risk individuals, like men who have sex with men. HIV screening should be offered to all youth aged 13 years or older within healthcare settings by a healthcare provider or a paediatrician. Those who are sexually active should be screened annually, and potentially every 3–6 months if they are at high risk. Paediatricians and healthcare users should also promote risk-reduction counselling and access to pre-exposure and post-exposure prophylaxis in addition to HIV testing using less invasive testing methods.
These measures should all be conducted in safe environments that promote confidentiality and respect, which has been shown to increase engagement in HIV care post-diagnosis. Increasing the awareness of this approach to HIV testing on 27 June may be a catalyst to reducing the barriers to HIV testing in youth and increasing engagement with the annual testing regime.
GlobalData epidemiologists estimate that by the end of this year, there will be around 1.32 million people diagnosed and living with HIV in the US, 35,400 of whom are aged 13–24 years. GlobalData epidemiologists expect, however, that the diagnosed prevalent cases of HIV will increase to 1.4 million cases across the US by 2029, 35,300 of which will occur in people aged 13–24 years. Despite this, if targeted youth testing initiatives are successful going forward, cases will likely surpass current forecast estimates due to increased awareness and case identification. It is important that the proposed annual testing regime is introduced and accepted by healthcare professionals and citizens across the US to reduce HIV transmission and overall disease prevalence.