HIV

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• Policies & Practices
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• References

The Problem

CDC estimates that more than 1.1 million people in the United States are living with HIV, and 15.8% (about one in six) are not aware they are infected.²

More about the problem

HIV and AIDS remain a persistent problem for the United States. In 2010, the White House released the first National HIV/AIDS Strategy for the United States to increase the nation’s sense of urgency and improve the response to the ongoing HIV epidemic.¹

The Prevention Status Reports highlight—for all 50 states and the District of Columbia—the status of three key policies and practices that state health departments can use to improve the health of people living with HIV infection and prevent the spread of HIV:

• Facilitating state Medicaid reimbursement for routine HIV screening
• Making state HIV testing laws compatible with CDC’s 2006 HIV testing recommendations
• Reporting all CD4 and HIV viral load data to the state surveillance program

These policies and practices reflect recent scientific advances in HIV prevention and medical care, create new opportunities for substantially reducing new HIV infections and HIV-related illness and death, and are important state-level tools that further the goals of the 2010 National HIV/AIDS Strategy.¹

Policies & Practices

CDC and the US Preventive Services Task Force recommend that adolescents, adults, and pregnant women be screened for HIV, regardless of risk.^3,4

Facilitating state Medicaid reimbursement of healthcare providers for routine HIV screening helps further the goals of the 2010 National HIV/AIDS Strategy.¹ One goal of the strategy is to ensure that by the year 2015, 90% of people living with HIV know their infection status.¹ Early HIV diagnosis is important for preventing new HIV infections and ensuring that people with HIV are able to receive medical care that will improve their health and reduce the risk of premature death.^4,5 All state Medicaid programs cover medically necessary HIV testing. The Centers for Medicare & Medicaid Services encourages state Medicaid programs to reimburse for routine HIV screening regardless of risk.⁶ Reimbursement increases the availability of routine HIV screening for low-income populations.^3,7

Status of state Medicaid reimbursement for HIV screening, United States (as of January 1, 2013)

(State count includes the District of Columbia.)

State HIV testing laws

Making state HIV testing laws consistent with CDC’s 2006 HIV testing recommendations helps further the goals of the 2010 National HIV/AIDS Strategy.¹ HIV testing enables individuals with HIV to become aware of their health status and to access medical care and treatment. Studies show that individuals who know they have HIV are less likely to trans­mit the virus to others.¹ State laws can facilitate access to HIV testing.

Status of state HIV testing laws, United States (as of July 2013)

(State count includes the District of Columbia.)

Reporting of CD4 and HIV viral load data to state HIV surveillance program

Reporting all CD4 and HIV viral load results (detectable and undetectable) to the state HIV surveillance program helps further the goals of the 2010 National HIV/AIDS Strategy.¹

CD4 and HIV viral load data are critical to the medical care and health of people living with HIV. These data are used to ensure that people with HIV are linked to and retained in medical care, which improves their health and prevents new HIV infections by controlling the virus and reducing the risk of HIV transmission.⁵

An HIV viral load test measures the amount of virus in a person’s blood. A CD4 lymphocyte count provides a measure of a person’s immune function and is used for determining the stage of HIV infection. Among people with HIV, CD4 results are often used to monitor disease progression and to time clinical care, and both HIV viral load and CD4 results are used to assess response to treatment.

Status of reporting of CD4 and HIV viral load data to state HIV surveillance program, United States (as of July 2013)

(State count includes the District of Columbia.)

Prevention Status Reports: HIV, 2013

The files below are PDFs ranging in size from 100K to 500K.

References

1. White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States[PDF 1.36MB]; 2010.
2. CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 U.S. dependent areas—2011[PDF 1.07MB]. HIV Surveillance Supplemental Report 2013;18 (No. 5).
3. CDC. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR 2006;55(RR-14):1-17.
4. Moyer VA, on behalf of the U.S. Preventive Services Task Force. Screening for HIV: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine 2013; Apr 30.
5. CDC. Vital Signs: HIV prevention through care and treatment—United States. MMWR 2011;60(47):1618–23.
6. Centers for Medicare & Medicaid Services. Letter to State Health Officials[PDF 56.7KB]. Jun 24, 2009.
7. Kates J. Medicaid and HIV: A National Analysis[PDF 1.57MB]. Menlo Park, CA: Kaiser Family Foundation; 2011.