In 2020, there was a 17% decrease in new HIV diagnoses and significant reductions in HIV testing in health care and non-health care settings, impeding the Ending the HIV Epidemic initiative to increase testing and reduce infections.
The COVID-19 pandemic disrupted HIV testing efforts in the United States, leading to significant decreases in HIV testing and new diagnoses, according to a report published by the CDC for the Morbidity and Mortality Weekly Report.
Decreases in testing and diagnoses were reported across all racial and ethnic groups and significantly impacted priority populations at risk for HIV acquisition, including gay and transgender men, among others. The Ending the HIV Epidemic in the US (EHE) initiative aims to reduce new HIV infections by at least 90% by 2030, with HIV testing as a core strategy.
During 2020-2021, the COVID-19 pandemic disrupted health care delivery during a time in which jurisdictions funded to conduct activities as part of the US EHE effort were beginning to expand testing and other HIV prevention activities. Disruptions included persons avoiding these services to comply with COVID-19 risk mitigation efforts and the redirection of sexual health services to COVID-19-related activities.
To understand the effect of the COVID-19 pandemic on HIV testing, the CDC analyzed the number of HIV tests conducted and HIV infections diagnosed by positive test result in the United States in the year before the pandemic, 2019, and during the pandemic, 2020.
Data on HIV tests were sourced from the Health Resources and Service Administration’s Uniform Data System, the CDC’s National HIV Prevention Program Monitoring and Evaluation System (CDC NHM&E), and the National Syndromic Surveillance Program. Data on HIV diagnoses was gathered from reports to the National HIV Surveillance System.
Difference in HIV testing by race and ethnicity and by population group were estimated from CDC NHM&E data. The results of the analysis showed a 17% decrease in new HIV diagnoses in 2020 compared with 2019.
An analysis of commercial laboratory testing showed that testing volumes remained stable throughout 2019, but by week 12 of 2020, testing volumes declined to <50% of levels in 2019 and remained low. Overall, 14.7% fewer commercial laboratory tests were reported in 2020 compared with 2019. The total number of HIV tests funded by the CDC and distributed in both health care and non-health care settings decreased by nearly one-half in 2020 (42.6% and 49.55%, respectively).
Substantial decreases in HIV testing were experienced in all racial and ethnic groups, as well as groups with an elevated potential for HIV acquisition, including Black or African American gay men, Hispanic or Latino gay men, bisexual men, other men who have sex with men (MSM), and transgender persons in CDC-funded jurisdictions. A 49.2% reduction in tests among MSM, a 47.3% reduction among transgender persons, and 44.1% and 46.3% reductions and Black and Hispanic persons, respectively, were reported.
The results also show similar declines in clinical visits for HIV testing and other services, such as STD testing. The CDC suggests that there is a need to compensate for testing and diagnoses missed during the COVID-19 pandemic.
“The substantial reduction in testing and new diagnoses suggest that a concerted effort is needed at local, state, and national levels to increase testing rates among all persons, especially those populations most affected by HIV, in keeping with EHE goals,” the CDC wrote in the report.
Suggested strategies to increase access to HIV testing services included self-testing and routine opt-out screening in health care settings. Distribution of HIV self-tests increases awareness of HIV infection among priority populations such as MSM, according to the report.
These efforts could also accelerate the EHE initiative. The expansion of routine screening in health care settings and locally tailored HIV testing efforts in non–health care settings would contribute to the EHE goal of reducing disparities in HIV diagnoses among populations most affected by the disease, the CDC notes.
The findings in the report are subject to limitations. The cause of decreases in the number of reported HIV tests and new HIV diagnoses can not be definitively determined. The CDC suggests that the decline may be a result of reduced access to testing services, decreased sexual behaviors that would make testing unnecessary, reductions in overall HIV incidence, or a combination of these and other factors.
DiNenno EA, Delaney KP, Pitasi MA, MacGowan R, Miles G, Dailey A, et al. HIV Testing Before and During the COVID-19 Pandemic—United States, 2019–2020. CDC Website. https://www.cdc.gov/mmwr/volumes/71/wr/mm7125a2.htm?s_cid=mm7125a2_w. Published June 24, 2022. Accessed July 13, 2022.