We have easy access to screening and diagnostic tests that can help eradicate one of the most widespread viruses of our time, HIV, yet we fail to use them. As a result, the rates of this disease are still at epidemic levels. I know this story all too well as an HIV researcher for the past 15 years.
This year, World AIDS Day on Dec. 1 marked its 30th anniversary with a renewed call to know your status. Your health and your life could depend on it.
We have effective ways of preventing HIV: testing, prevention pills (pre-exposure prophylaxis, or PrEP, and post-exposure prophylaxis, PEP), using condoms and clean needles, behavioral change interventions and addressing social determinants of health.
While the rates of undiagnosed HIV infection across New York have improved since the introduction of Gov. Andrew M. Cuomo’s “Blueprint on Ending the AIDS Epidemic,” the state Department of Health says there are about 9,000 New Yorkers with HIV who don’t know their status. While all health care providers in New York State are required to routinely offer an HIV test to everyone 13 and older, many don’t. And many who need the test refuse it.
Patients who refuse often cite cost, low perceived risk and fear of stigmatization. Physicians, meanwhile, say competing clinical priorities, time constraints, a complicated consent process, lack of training on testing technology, and inadequate reimbursement are major reasons for not offering the test. To address these issues, the New York State Department of Health recently launched “Expect the Test,” a campaign to remove some barriers to HIV testing and raise awareness that state public health law requires all health care providers to offer the test.
What can the higher education community do? I propose mandatory HIV testing for all students entering college. The American College Health Association already recommends immunization and vaccination requirements for college students and encourages colleges to screen for tuberculosis.
I understand the complexities associated with scaling up population-based services. They include privacy, confidentiality, counseling and consent issues. And I realize that mandatory testing of college students is a controversial idea that might never happen. But I also know that we aren’t going to end the epidemic unless we change testing attitudes. So, let’s at least start talking about a bolder approach to the issue.
Mandatory testing also might help reduce HIV stigma because it would become a routine part of care needed to protect students and the larger campus community. More important, it would help meet the Centers for Disease Control and Prevention guideline that everyone between 13 and 64 years old get tested for HIV at least once. Moreover, this type of initiative would address one goal of the state blueprint — to identify people with HIV who remain undiagnosed and link them to health care.
Requiring students to be tested could make a meaningful dent in the high rates of undiagnosed HIV among youth. In 2016, the CDC reported youth ages 13 to 24 comprised 21 percent of all new HIV diagnoses. Moreover, only 56 percent of HIV-infected youth in the United States are aware of their condition. Unfortunately, many young people get tested only after becoming sick.
People living with HIV have access to safe, effective treatments (including a pill a day), with few side effects. Let’s give everyone this chance to live a long, fulfilling life by expanding HIV testing efforts and raising awareness about the importance of knowing one’s status.
New York was the first state to develop a formal, centralized program in response to the epidemic. We should be first with other trailblazing and forward-thinking public health initiatives as well. I urge you to get tested. To find an HIV testing location near you visit locator.hiv.gov.
Anthony J. Santella is an associate professor of public health at Hofstra University and chair of the Nassau-Suffolk Ryan White HIV Planning Council.