Less than 1% of visits to the emergency room included an HIV test in 2019 and 2020, according to findings published in the February 2024 issue of AIDS. This is despite the federal recommendation that people in health care settings should be tested for HIV unless they decline (referred to as opt-out screening).

What’s more, compared with other U.S. regions, the South saw the lowest rates of HIV testing in ER settings: 0.6% in 2019 and 0.5% in 2020. Compared with metropolitan areas, rates in the more rural South were even lower (0.1% or less each year).

This is notable because for several years, the South has been the epicenter of our nation’s HIV epidemic, particularly for people of color. In 2021, the South comprised 38% of the U.S. population but 52% of new HIV diagnoses, according to data from the Centers for Disease Control and Prevention (CDC).

As POZ noted on the occasion of this year’s Southern HIV/AIDS Awareness Day (#SHAAD), celebrated annually on August 20, several factors contribute to higher HIV rates in the South, including poverty, unemployment, stigma, lack of access to care in rural areas and a lag in testing, treatment and education. In addition, many Southern states have not expanded Medicaid, the health insurance program for low-income and disabled Americans that is the largest source of health coverage for people living with HIV in the United States.

In addition, the CDC estimates that around 14% of the 1.2 million people living with HIV nationwide do not know they carry the virus, and nearly 40% of new HIV cases are transmitted by people who don’t know their status. (For more background, see the POZ Basics on HIV Testing.)

Thus, failing to test people for HIV when they are at the ER amounts to a missed opportunity to diagnose and connect folks to care. It is well established that emergency departments can offer vital access to HIV services. For a recent success story, see “Seattle ER Team Honored as ‘Ending the Epidemic Heroes’” and the related “Emergency Departments Can Facilitate Linkage to HIV Care,” about providing antiretroviral starter packs to people who test positive.

To determine the rate of HIV testing in ER settings, researchers led by Carson E. Clay, a medical student at New York University Grossman School of Medicine, looked at the proportion of emergency department visits between 2014 and 2020 that included HIV testing. As they explained: “We performed a cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS), a weighted nationally representative survey of U.S. emergency departments.”

The researchers found a “small but insufficient increase” in testing rates during that period. Specifically, rates increased from 0.6%) in 2014 to 1.1% in 2018 but then dipped to 0.8% n in 2019 and 2020.

However, when people visited the ER for issues that could be linked with HIV—such as a sexually transmitted infection, pregnancy or sexual abuse—then 5.1% were tested for HIV, noted aidsmap.com in its report on the study.

“Overall, very few emergency department visits during our entire study period included an HIV test,” the researchers wrote, “and there were persistently low rates of HIV testing for populations prioritized in national efforts and during visits in rural jurisdictions in the South.”