Mass Mailing of HIV Self-Tests to Persons Disproportionately Affected by HIV in the U.S.

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In the United States as of 2019, an estimated 13% of persons with HIV were unaware of their HIV infection. This group accounts for a disproportionate number of new infections each year. Gay, bisexual, and other men who have sex with men (MSM) accounted for approximately 70% of new infections annually in the U.S.  Traditional healthcare venues and their access barriers often result in inadequate engagement with HIV testing, treatment, and prevention services. Socioeconomic factors, cultural norms, stigma, homophobia, and discrimination are associated with reduced access to HIV testing, prevention, and treatment. The long-standing and intersecting inequities in access to services both increase HIV infection rates and hinder access to testing services in traditional clinical or community settings. Black or African American (hereafter referred to as Black) and Hispanic/Latino (hereafter referred to as Hispanic) MSM are more severely affected by HIV than other populations. In 2019, Black and Hispanic MSM accounted for 37% and 32% of MSM diagnosed with HIV, respectively. Transgender women (TGW) are also disproportionately affected by HIV, and racial and ethnic disparities are also seen among TGW.  National HIV Behavioral Surveillance data (2019-2020) reported that 62% of Black TGW and 35% of Hispanic TGW were living with HIV compared to 17% of White TGW.  In 2019, 54% of infections among women were in Black women. A recently completed pilot project that distributed 100,000 HIVSTs with focus on these population groups found success distributing tests to all groups by mail and that overall, 26% of those who ordered a test reported they have never previously tested for HIV. (CDC Contract# 75D30120C09658). This project supports the first pillar of EHE by increasing the percentage of persons diagnosed with HIV. This program will provide HIVSTs to communities most affected by HIV. Effective HIV prevention services, including the opportunity to more frequently test for HIV, are needed to reach these populations. This program will provide free HIVSTs and resources for accessing HIV preventive services to people in communities most affected by HIV. Most Americans are using the internet for a variety of purposes. Using tailored advertising materials and strategies developed by CDC, web-based information about HIV testing, prevention and treatment services will be provided.  This online approach is effective in increasing awareness of HIV infection outside of traditional brick-and-mortar testing sites. This has been demonstrated by recent research on the distribution of HIVSTs to MSM (Contract #200-2011-41989), and the pilot national HIVST distribution program. The direct-to-consumer distribution of HIVSTs represents a timely approach and complements existing local and national HIV testing efforts. Distributing HIVSTs can further leverage existing public health prevention efforts to reduce the number of persons with undiagnosed infection, and provide resources to help access treatment and prevention services.  These efforts will contribute to the goals of reducing HIV transmission and preventing HIV disease progression. The CDC Let’s Stop HIV Together campaign (Together) is a comprehensive HIV prevention, testing, treatment and stigma reduction campaign. This program will be conducted with substantial involvement from CDC. Close collaboration with CDC will ensure that populations most in need of HIVSTs are reached through advertising, are able to order HIVSTs, and receive messages regarding HIV prevention and treatment.

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