The predominant barrier of routine HIV testing by African-American frontline care physicians is social stigma, according to a investigation assigned by Janssen Therapeutics, Division of Janssen Products, LP, in conjunction with the National Medical Association (NMA). Even though most physicians surveyed (93%) believed HIV was either very serious or a crisis in the African-American community, findings indicated that as little as one-third of all patients in these physician practices were tested in the past year.
The number of individuals living with HIV infection is at its highest in the United States. Almost half of all new HIV infections are accounted for by African-Americans, who also represent a higher proportion of new cases in comparison with other races and ethnicities. Since September 2006, the Centers of Disease Control and Prevention (CDC) has advised diagnostic HIV testing and voluntary HIV screening to be included in routine clinical care in all healthcare settings.
Wilbert C. Jordan, MD, MPH, Medical Director of the OASIS Clinic of King/Drew Medical Center and member of the NMA said:
“These findings tell us that despite HIV education efforts, the stigma surrounding the disease is still very strong and is a significant barrier to routine testing among African-American doctors.
With African Americans more likely to contract HIV than any other ethnic group, this is particularly concerning as the study uncovered that most patients decide to get tested based on their physicians recommendation. Its crucial that we educate doctors and patients by providing the resources they need to make HIV testing a routine practice.”
Testing Recommendations Tend to be Prompted by Risky Behaviors
Physicians surveyed estimated that 70% of patients got tested within the past year due to physicians’ recommendations, however, the physicians surveyed often use a risk-based testing method, recommending HIV testing for people based on perceived high-risk behaviors, which include multiple sex partners (89%), injection drug use (85%), suspected prostitution (77%), homosexuality (77%), and previous incarceration (70%). 86% of physicians found it is easiest to raise HIV testing with patients who are believed to be at risk.
Variance in Testing Based on Physician Demographics
36% of all physicians investigated were classified as high testers, routinely testing over 25% of their patients for the disease. The physicians tended to test routinely for all sexually active patients, those under 40, females and were more likely to be specialized in obstetrics and gynecology.
Recommendations by Physicians to Increase Routine HIV Testing
Physicians investigated suggested solutions to help boost routine testing in the primary care setting. Their suggestions included patient-focused communication emphasizing the importance of getting tested, for instance in-office posters and brochures (52%) and increased media attention (51%), further training on testing (44%) and the accessibility of accurate in-office prepackaged HIV tests (42%). Several physicians said that having a government order requiring routine HIV testing would enable them to test more patients (43%), despite the 2006 CDC recommendations for HIV testing.
Cedric Bright, MD, President of the NMA said:
“Early detection of HIV is critical, and thats why its important to raise awareness of the need for annual HIV testing as part of routine blood work.
The NMA supports and encourages its physicians in the primary care arena to adopt annual HIV testing of their patients. Together we can help make a difference in the fight against HIV.”
At the NMA Conference or via email, a total of 502 surveys were completed by African-American physicians online, 65% were NMA members. The survey consisted of 38 survey questions and 11 screening questions. The online panel surveys were gathered in two stages, late July through to early August 2010, and the second from mid-October through early November 2010. The intercept surveys from the NMA Conference were gathered in early August 2010, while in mid-September to mid-October the post conference email survey data was collected.