June 27 marks the 20th anniversary of National HIV Testing Day, an annual observance to promote and educate Americans about the importance of being tested, particularly these days when HIV is not seen as the threat it once was. The Centers for Disease Control and Prevention (CDC) recommends that everyone ages 13 to 64 be tested for HIV at least once as part of routine health care. People with risk factors, such as gay and bisexual men, people with more than one sex partner, people with sexually transmitted diseases and people who inject illegal drugs, should be tested at least once a year.
Unfortunately, many people with HIV have not been tested. In 2011, an estimated 1.2 million people in the United States were living with HIV, and of these one in seven — or 14 percent — are thought not to have been tested. The implications are both tragic and costly. HIV testing is the first step to obtaining treatment. People with HIV should be linked to care and need to remain in care. Unless they learn of their health status early through testing, they won't learn until symptoms emerge when they will need more and higher levels of care, including hospitalization.
HIV is increasingly a disease of poverty. Among people diagnosed with HIV, incidence is highest in regions where unemployment and poverty are most prevalent and education levels are lowest. African-Americans are also disproportionately affected: Although they make up only 13 percent of the general population, 58 percent of people diagnosed with HIV are African-American. This population is also less likely to be tested: 41 percent of people with HIV who have not been tested are African-American.
Why don't people get tested? At the intrapersonal level, people's beliefs about themselves, their risks and their environments (such as the perception that one is not at risk) keep them from being tested. At the interpersonal level, interactions with others — such as health-care providers being perceived as unhelpful, insensitive or judgmental — can dissuade people from being tested or from entering and staying in treatment. At the structural level, several factors, such as lack of access to facilities and health-care providers where HIV testing is provided, can keep people from getting tested and into care. Some states where HIV incidence is highest are those in which Medicaid has not been expanded. Poverty indices are associated with all of these levels.
Psychologists have the training and expertise to help change all of these disheartening facts. Within the context of individual therapy, practicing psychologists (particularly those who work with socially and economically disenfranchised people) can introduce the need for HIV testing as part of general health care in their work with clients even though they may not appear to be at risk. Psychologists in academic health-care centers can educate providers, psychology students and medical residents about the factors that hinder people from accessing and remaining in the health-care system. Community psychologists can work to increase the visibility and accessibility of testing and health care. Psychologists in administrative positions can work to make health care more accessible and welcoming to patients. Psychologists involved in training can redouble efforts to recruit students representing groups at risk for HIV and other poverty-related health issues. For more information or to become involved in APA's HIV-related activities, visit HIV/AIDS, Public Interest Directorate Web pages.
To learn more about this and other offices in APA's Public Interest Directorate and the important work we do, join me and my colleagues at APA's Annual Convention in Toronto, Aug. 6–9, for Public Interest Directorate sessions and events. Visit Public Interest for our convention highlights. I hope to see you there.
