Lack of Testing Fuels Growing Number of Undiagnosed HIV in the U.S.

Lack of Testing Fuels Growing Number of Undiagnosed HIV in the U.S.

Pensive teenager looking through a window

Arecent study by Northwestern University reveals that the majority of teenage boys at risk for transmission of HIV have never been tested for the virus, fueling the growing number of people with undiagnosed HIV in the U.S.
An estimated 14.5% of people with HIV do not know they carry the virus because they have never been tested. However, among 13- to 24-year-old young men, that rate is three times higher, at 51.4%.

The study, published on February 11, 2020, in the journal Pediatrics, found specifically that (a) fewer than one in four gay, bisexual and questioning teenage boys (under 18 years old) has ever received an HIV test, and (b) among teenage boys engaging in condomless anal sex, only one in three reports testing for HIV.

The study found that this group of boys, 13 to 18, is disproportionately at risk to acquire HIV but faces structural barriers that hinder testing——they do not know that they can legally consent to getting an HIV test, they do not know where to get tested, and they fear being outed to family and friends if they do test. The study identified factors that increase the likelihood of testing, including parents talking about sex and HIV prevention, knowing basic facts about HIV, and feeling that testing is important and that they are empowered to do it. When these factors were considered together, the most important factor was having had conversations with their doctors about HIV, same-sex behavior and sexual orientation.

Brian Mustanski, director of the Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH) at Northwestern University Feinberg School of Medicine and the senior author of the study, said in a press release, “Doctors——pediatricians in particular——need to be having more frank and open conversations with their male teenage patients, including a detailed sexual history and a discussion about sexual orientation——ideally a private conversation without parents present. If parents ask their teen’s provider to talk about sexual health and testing, this may be enough to start that key dialogue in the exam room, leading to an HIV test.”

Mustanski asserted that pediatricians can help to alleviate this growing crisis if they update their intake forms to include a section on sexual orientation, let patients know that their office is a “safe zone” for discussing sexuality, and reinforce confidentiality by asking patients’ parents to leave the room before the discussion begins. Physicians can also inform patients that they can get testing in many community organizations. (A map of these clinics can be found at

“To promote these options, we need health education programs that teach teens about their legal rights to testing, the importance of testing and how to go about it,” said co-author of the study Kathryn Macapagal. “Our team developed a program that addresses these needs for teens, and we expect the results of our nationwide trial to come out soon.”
For more information on the Northwestern University study, log on to:

Reporting by Hank Trout

Hank Trout, Senior Editor, edited Drummer, Malebox, and Folsom magazines in the early 1980s. A long-term survivor of HIV/AIDS (diagnosed in 1989), he is a forty-year resident of San Francisco, where he lives with his husband Rick. Follow him on Twitter @HankTroutWriter.