Getting Back on Track
HIV Testing Rates Dropped During COVID
by Hank Trout

According to an April 21, 2021, report by NPR, rates of testing for HIV fell to troubling levels during the COVID-19 pandemic.

During the lockdowns put in place to contain the spread of COVID, clinics limited in-person visits; doctors’ offices and emergency rooms halted routine HIV tests; rapid-testing vans ceased operation; medical personnel were diverted from HIV/AIDS work to COVID-19 response; and in the city, county, state, and federal agencies, health expertise became focused singly on COVID.

Nearly 700,000 fewer HIV screening tests were conducted across the U.S.—a 45% drop—and 5,000 fewer diagnoses between March and September 2020, compared with the same period the year before. Prescriptions for PrEP also have fallen sharply. State public health departments have recorded similarly steep declines in testing. Alliance for Positive Change, a local nonprofit that has served New Yorkers with HIV/AIDS and other chronic health conditions for thirty years, recorded a drop nearly 40% in HIV testing during COVID. The nation’s HIV surveillance system cannot monitor the virus’s movement for the first time in decades.

While the impact of this drop in HIV testing is just beginning to be felt, it is clear that the impact will be the most severe in the Southern states, which account for 51% of new transmissions, eight of the ten states with the highest rates of new diagnoses, and half of all HIV-related deaths, according to the most recent data available from the Centers for Disease Control and Prevention. “This is a major derailing,” Dr. Carlos del Rio, a professor of medicine at Emory University in Atlanta and head of the Emory AIDS International Training and Research Program, told NPR. “There will be damage. The question is, how much?”

A&U corresponded with Sharen Duke, founding CEO and executive director of Alliance for Positive Change, about the COVID-related reduced rate of HIV testing.

Sharen Duke, founding CEO and executive director of Alliance for Positive Change. Photo courtesy Alliance for Positive Change

Hank Trout: NPR reported that, due to these COVID-related changes, “For the first time in decades, the nation’s lauded HIV surveillance system is blind to the virus’s movement.” Please discuss some of the real-world effects of this “blindness.”
Sharen Duke: When we administer fewer HIV tests, we identify fewer HIV-positive individuals, which subsequently delays getting them connected to care, on treatment, and finally, undetectable. Knowing how many individuals we have along each step of this path (known as the HIV treatment cascade) is critical.

During the pandemic, we lost a year of data for all of these categories. Cascade data helps us identify trends in infection, allowing us to target specific communities with culturally competent prevention information and testing. It also informs where our government partners allocate funding for our communities, in order to ensure specific communities are receiving help proportionally to their needs.

The region of the country most impacted by these changes is the South. Can you discuss the cultural/religious/economic factors that contribute to that disproportionate prevalence of HIV transmissions and deaths?
In New York City, we are lucky to have dedicated resources to fight the HIV epidemic, robust public benefits, expanded Medicaid, and the commitment from our taxpayers and government to make funding available. At Alliance, we often see people migrating from the South in their quest to access medications and treatment in New York City—as well as public benefits support towards housing and affordable medications, among others.
There are geographical accessibility issues in the South, where health clinics are often many miles away. Other factors, such as stigma and discrimination, present additional barriers to HIV prevention and treatment services. Given the higher rates of transmission in the South, it’s likely that many of these intersecting factors hinder access to culturally competent care.

The lack of healthcare insurance has had a detrimental effect on HIV testing and services since long before COVID-19, particularly in those states that refused to expand Medicaid coverage under the ACA. Has the lack of healthcare insurance contributed to the drop in HIV testing and other services during COVID? If so, how?
COVID-19 has certainly exacerbated a lot of the entrenched health inequities that disadvantaged communities face in our nation. During the pandemic, more people were out of work and without health insurance—these people were disproportionally from lower-income brackets. Access to insurance is absolutely a barrier to health equity in general. I believe policymakers and funders need to look at alternatives to traditional medical settings to make testing available to everyone. We must overcome the barriers to widespread access to all health screening and services, nationwide.

Although no one can predict the exact long-term repercussions of these COVID-related obstacles, what do you think the worst, long-lasting damage to HIV tracking and treatment might be?
In terms of tracking cases, we lost a year of crucial data. It’s worth repeating that this will make it much harder for service organizations and government funds to reach the communities most affected by HIV.

Finally, what actions can the government and ASOs take to mitigate that damage? Or is it too late now?
It’s not too late. Governments on all levels can invest money and resources—we especially must continue to invest in Medicaid, so that people have access to the full array of services they need and deserve. The government can also engage with ASOs to increase community vaccination efforts, which help mitigate barriers to accessing care. The importance of getting tested for HIV/HCV/COVID-19 and knowing your status, in order to protect yourself and those around you, cannot be overstated.

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.