Patrick Sullivan, PhD
Principal Researcher, AIDSVu
Associate Professor of Epidemiology, Rollins School of Public Health, Emory University

How can mapping the HIV epidemic help healthcare providers talk to patients about getting tested?

An estimated one in five individuals living with HIV in the United States don’t know they are infected, according to the Centers for Disease Control and Prevention (CDC). CDC recommends routine HIV screening among persons aged 13-64, but many individuals, due to the lingering stigma around the disease, are hesitant to talk about HIV with their doctors or to ask to be tested. Healthcare providers often do not test patients because they perceive that the patients do not fit a risk profile or because the providers are not comfortable assessing and discussing HIV risk behaviors.

In recent years, it has become increasingly clear that an individual’s risk of becoming infected with HIV can’t be reliably assessed based on whether he or she fits a certain risk profile – just living in an area where HIV prevalence is high is enough reason to screen patients for HIV. A visual representation of the geography of HIV prevalence – that is, the number or density of people living with an HIV diagnosis – can help healthcare providers understand just how much HIV affects the people in their communities and talk to patients about the importance of getting tested.

AIDSVu (www.aidsvu.org) is an interactive online map that allows visitors to visually explore the HIV epidemic in the United States by state, county and, in some cases, zip code. The map allows users to filter HIV prevalence data by race/ethnicity, sex and age. This data is displayed alongside key information such as HIV testing center locations, poverty rates and NIH-funded HIV prevention and vaccine trial sites. The HIV data is collected by state and local health departments, and reported to CDC, which provides this data for presentation on AIDSVu.

So how can healthcare providers use AIDSVu maps to talk to patients about testing? As you know in your work, diagrams and images can be helpful in explaining a complicated health condition or problem to a patient. The same goes for HIV. AIDSVu’s maps are easy to understand and show clearly where prevalence of HIV is especially high.  This may help patients understand why routine testing is important, regardless of their personal assessment of behavioral risks.

Providers can download or print maps from AIDSVu that show the prevalence rates and numbers of cases for their states and counties. Providers may find that posting a printed map in exam rooms and offices can help start a conversation with patients about the impact of HIV in their community, and the CDC-recommended routine screening.

AIDSVu also provides state-specific information pages that include details on AIDS drug assistance program waiting lists, state STD rates and late HIV diagnosis rates. The late diagnosis rate, an estimated percentage of adults/adolescents diagnosed with AIDS within 12 months of initial HIV infection diagnosis, is a compelling statistic that providers can use to emphasize the importance of HIV testing and early diagnosis. In addition, AIDSVu offers a testing locator and links to national and local HIV programs and organizations for patients who might want referral to more in-depth counseling about HIV risks than can be provided in an office visit.

What do you think about how providers might use prevalence maps to discuss HIV with patients, and how else might you use the maps on AIDSVu?