HIV testing fees and reaching the uninsured
This month, the Mississippi State Department of Health announced a change to HIV and sexually transmitted infection (STI) testing. In response to state budget cuts, HIV and STI testing will no longer be offered for free. Beginning July 1, many people seeking testing will be required to pay a $25 fee to cover the cost of testing and associated lab work. Some people may be able to pay on a sliding fee scale, and testing will continue to be free for people under age 18.
“This is a big deal,” said Dázon Dixon Diallo, DHL, MPH, CEO of the Atlanta-based HIV nonprofit SisterLove. “A fee of $25 can be formidable for some [people].”
States in the South—particularly Mississippi—are disproportionately impacted by HIV, with the South accounting for the highest rate of new HIV diagnoses in any region (18.5 per 100,000 people, compared to 11.2 in the West, 8.2 in the Midwest and 14.2 in the Northeast). Mississippi has the sixth highest rate of new HIV diagnoses in the U.S. (17.0 per 100,000 people). The capital, Jackson, has the fourth-highest rate of new HIV diagnoses of U.S. cities, with an astounding diagnoses rate of 31.3 per 100,000 people. The majority of new HIV diagnoses (67%) are among men who have sex.
Free and low-cost HIV testing can increase motivation to test for HIV and improve uptake, particularly in areas of low socioeconomic status (which are oftentimes hardest-hit by HIV). In a study of young men who have sex with men in six U.S. cities, one team of researchers concluded that outreach—with free testing options—is critically important in getting people who don’t regularly test to do so.
“Our findings suggest that some young MSM [men who have sex with men] use health care infrequently, some delay testing because they do not use a regular source of health care, and as also suggested by other reports, many will take advantage of free testing at MSM-identified venues,” said MacKellar and colleagues.
SisterLove, explained Diallo, offers free HIV testing to many people who are low- or no-income, including students. “These are people who are less likely to prioritize getting tested for HIV if there’s a cost and they don’t have money for it,” she said.
Racial and socioeconomic disparities in HIV may be exacerbated when regular HIV testing becomes financially untenable for some people, said Joshua O’Neal, the director of sexual health services at San Francisco AIDS Foundation. Raising the cost of HIV tests “wouldn’t impact everybody in the same way,” he said. “It would make folks that are part of hard-to-reach populations even more invisible. This might include sex workers, queer people of color, people of low socioeconomic status or people who have relationships with substances.”
When was the last time you were tested for HIV? San Francisco AIDS Foundation recommends that every sexually active person get tested for HIV at least once per year. If you are an HIV-negative cisgender man or trans person who has sex with men, the foundation recommends testing every three months.
People in San Francisco may access free HIV testing from San Francisco AIDS Foundation. Find an HIV testing site near you.