Time to step up HIV testing in women

Review the last three patient charts: a 19-year-old college student, a 26-year-old mother of two, and a 43-year-old woman who is newly divorced. Which women were offered screening for HIV?

All of them, if your practice is following new guidance issued by the American College of Obstetricians and Gynecologists (ACOG).1 The ACOG recommendations fall in line with those issued in 2006 by the Centers for Disease Control and Prevention (CDC) calling for voluntary HIV screening among all patients ages 13-64.2

The ACOG recommendations call for routinely screening all women between ages 19 and 64 for HIV. Targeted screening should be performed in women outside the age range who are at high risk, such as sexually active teens under age 19 and women older than 64 who have had multiple partners in recent years, the ACOG guidance advises.1

HIV testing rates have remained fairly stable from 2001 through 2006. While 10% of adults ages 18-64 report getting tested each year, the percentage of people who report ever being tested in their lifetimes has not increased, according to new surveillance from the Centers for Disease Control and Prevention (CDC).3

HIV testing is the essential first step in linking people with HIV to medical care and ongoing support to help them maintain safer behaviors, says Melissa Shepherd, acting chief of the CDC's Division of HIV/AIDS Prevention's Technical Information and Communications Branch. Most new infections are believed to be transmitted by individuals who are unaware of their infection, says Shepherd. Studies show that once individuals learn they are HIV-infected, most will take steps to protect their partners, she notes.

Women of color at risk

While all women should be screened for HIV, providers and their patients must be aware that women of color are disproportionately affected by the disease, advises a second committee opinion issued by ACOG.4

The CDC estimates 56,300 HIV infections occurred in the United States in 2006. According to the CDC analysis, infection rates among blacks were seven times as high as whites (83.7/100,000 people versus 11.5/100,000) and almost three times as high as Hispanics (29.3/100,000 people).5

Women of color are acquiring HIV at higher rates compared with other groups, says Maureen Phipps, MD, MPH, director of the research division of the obstetrics and gynecology department and associate professor in the departments of obstetrics and gynecology and community health at the Warren Alpert Medical School of Brown University in Providence, RI. "Being able to diagnose a person with HIV early on is important because they need to receive appropriate medications and on-going health care," says Phipps, who served as a co-author of the ACOG committee opinion. "Early diagnosis is also important for the person to become well-educated about how to prevent transmitting the disease to others."

The CDC is working to fight HIV among African Americans through the Heightened National Response, a partnership of CDC, public health partners, and African American community leaders. The partnership is designed to build upon progress in four key areas: expanding prevention services, increasing testing, developing new interventions, and mobilizing broader community action. One such initiative is "Take Charge. Take the Test," a one-year HIV testing social marketing campaign for African-American women in Cleveland and Philadelphia. The campaign, held October 2006 to 2007, promoted local toll-free HIV testing hotlines through radio, print, and billboard advertisements. Preliminary findings indicate that the campaign exposure led to increases in information-seeking behavior.6

Shepherd says, "Social marketing campaigns such as `Take Charge, Take the Test' about HIV testing are designed to increase knowledge of HIV status and to promote HIV risk reduction. "These campaigns are important components of the CDC's comprehensive program for HIV prevention."

References

  1. American College of Obstetricians and Gynecologists. ACOG committee opinion. Routine human immunodeficiency virus screening. Obstet Gynecol 2008; 112(2 Pt 1):401-403.
  2. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006; 55(RR-14):1-17; quiz CE1-4.
  3. Centers for Disease Control and Prevention (CDC). Persons tested for HIV -- United States, 2006. MMWR 2008; 57:845-849.
  4. American College of Obstetricians and Gynecologists. ACOG committee opinion. Human immunodeficiency virus and acquired immunodeficiency syndrome and women of color. Obstet Gynecol 2008; 112(2 Pt 1):413-416.
  5. Hall HI, Song R, Rhodes P, et al. Estimation of HIV Incidence in the United States. JAMA 2008; 300:520-529.
  6. Davis K, Uhrig J, Goetz J, et al. Effectiveness of an HIV testing campaign in increasing HIV hotline calls and HIV testing rates among African American women. Presented at the 136th annual American Public Health Association meeting. San Diego; October 2008.