Factors Associated with Lower HIV Testing Rates in an Insured Urban Population

Background: As of 2017 the Centers for Disease Control and Prevention (CDC) estimated that there were over one million individuals living with HIV/AIDS in the United States (CDC, 2017). Regionally the epicenter of HIV infection is in Washington DC with a prevalence rate of 1.9% (HAHSTA, 2018). Several wards including 5, 6, 7 and 8 are disproportionately impacted. Although the lack of insurance has been identified as a challenge for HIV detection and linkage to care, many insured individuals deny previous HIV testing. We implemented a routine HIV screening program in our institution since 2006. We present an analysis of our HIV testing data over a 42-month period to assess factors leading to lower HIV testing rates in an urban insured population. Methods: Rapid HIV screening was conducted using an opt-out methodology in the emergency department (ED) and an outpatient testing site (OTS) at Howard University Hospital (HUH). Data analysis was performed for clients aged 30-80 years. Results: Of the 20,008 adults tested the majority (92.4%) were African Americans (AA), and 52% were men. Overall 88 % had health insurance, most (74%) were covered by Medicaid. Out of those insured 9% (1637) reported no previous HIV testing. In this group (64%) were 50 years and older. Unprotected sex was the leading reported risk factor (19%). Conclusion: 1637 of those insured reported no previous HIV testing. Age greater than 50 and unprotected sex were significant risk factors. Health insurance status did not always correlate with previous testing. HIV prevention efforts should target this population with appropriate messaging and screening during routine evaluations