Insurance coverage and access to HIV testing and treatment: considerations for individuals at risk for infection and for those with undiagnosed infection.

The Centers for Disease Control and Prevention estimates that of the approximately 1.2 million people with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome in the United States, approximately 500,000 are not receiving care for their disease, including approximately 250,000 who do not know they are HIV positive. Although little is known about these 2 subgroups of HIV-infected people, they are likely to be reflective of the larger population of people with HIV infection; that is, they are predominantly racial minorities, more likely to be unemployed and/or poor, and much more likely to be uninsured or dependent on public insurance programs such as Medicaid, compared with the US population overall. In addition, many persons receive a diagnosis of HIV infection late during the course of the disease, and those who are difficult to reach are less likely to receive standard-of-care antiretroviral therapy. New testing initiatives attempting to diagnose infection in persons who do not know their HIV infection status have raised important questions about the funding and program capacity of the current system to handle new patients. Given these challenges and questions, measuring the success of new testing initiatives will be critical but difficult.