It's National HIV Testing Day

Posted by Guest Blogger at 5:35 AM on June 27, 2007.

This release, originally appeared on the Ms. Foundation for Women and was provided by Elizabeth G. Hines:

Women living with HIV in America rarely attract big headlines—not even when it comes to policies that impact their lives directly. But it’s not just the media that ignores the experiences of women living with HIV in the US; our major policy setting body on public health, the Centers for Disease Control & Prevention, continues to embrace standards on HIV testing that minimize the risk of infection to women—despite the fact that in the last 20 years, the percentage of women’s AIDS cases in America has more than tripled, rising from 8% in 1985 to 27% in 2005.

Today, HIV infection is the leading cause of death for African-American women aged 25-34 years. Decisions made by the CDC on who is “at risk” for contracting HIV are literally a matter of life and death. And one recently released report by a former CDC official offers a critical example of how women’s needs too often get left out of the policy agenda.

Earlier this month, David Holtgrave, an epidemiologist with the Johns Hopkins Bloomberg School of Public Health, released a report that challenges recent attempts by the CDC to mandate routine HIV testing among U.S. residents. Going against the grain of the CDCs new policy, Holtgrave suggests that targeting HIV testing of “high-risk” groups could be a more effective method of identifying those who are unaware of their HIV-positive status than conducting the routine testing within clinical settings the CDC now recommends.

We at the National Women and AIDS Collective applaud Dr. Holtgrave’s effort to create more accurate HIV testing policies and procedures. But we also know that unless targeted testing and universal testing are both a part of the picture—and fully funded—women will continue to fall through the testing system’s cracks. Why? Because the CDC’s current methodology for identifying risk is fatally flawed when it comes to women and HIV.

At present, the CDC defines those “at risk” for contracting HIV as: men who have sex with men; IV drug users; individuals with hemophilia/coagulation disorders; transplant recipients; and individuals who have sex with high-risk individuals. Pointedly not included in those categories are women who engage in heterosexual sex, who may not have any knowledge of the risk behaviors of their partners.

Increasingly, women are contracting HIV through men with whom they believed they were in monogamous relationships; but because monogamous heterosexual contact is not one of the “at risk” categories identified by the CDC, these women are categorized as “non identified risk.” Organizations in the field are now reporting that anywhere from 30% to 60% of women testing positive for HIV are being listed in this “non identified risk” category. And without an “at risk” categorization, women’s lives are left hanging in the balance: they are often discouraged from being tested by their doctors and their access to testing at federally funded sites significantly diminished. There is simply a resounding absence of prevention and testing campaigns focused on these women.

As a result, many women are not diagnosed until well into their illness, affecting both prevention and treatment. “At risk” definitions and prioritization not only have an impact on testing, they determine which groups are funded for prevention and direct services—further leaving women out in the cold.

Any recommendation that relies upon current risk categories for targeting “at risk” populations is necessarily, and dangerously, flawed. The kind of testing that Dr. Holtgrave recommends may do much to help identify more infected individuals recognized as being “at risk,” but it clearly does nothing for women who do not fit into an outdated system of defining risk.

With the numbers of women infected with HIV rising each year, it’s time for the CDC and others to get real about what a person “at risk” in America actually looks like. Twenty-five years into the epidemic, we know that one sexual contact is all it takes to acquire HIV. It is time for both public and private entities to provide the resources necessary to make sure that every individual, regardless of gender, is able to know their HIV status. Dr. Holtgrave is certainly right to argue that targeted testing is an important tool in the war on AIDS—but it is just one tool of many. Now, we must all be held responsible for making sure women don’t end up, once again, at the margins of this bull’s-eye.

The National Women and AIDS Collective (NWAC) is the first organized movement of HIV affected women to call for national policy change. For more information about NWAC and its campaign to revise or eliminate the CDC’s at-risk categories, please visit: http://ms.foundation.org/wmspage.cfm?parm1=421

For more information on National HIV Testing Day, please visit: http://hivtest.org/press_files/subindex.cfm?FuseAction=Spotlight.main

The Ms. Foundation for Women has been creating opportunities for women and girls for 30 years. We know that when we invest in women and girls, helping them develop their voices and skills, everyone benefits—men, boys, families, and communities.