Missed opportunities in HIV testing: Older New York City residents

Background: In 2006, the Centers for Disease Control and Prevention (CDC) recommended routine HIV screening for individuals aged 13-64 years in healthcare settings. Testing for persons aged ≥65 is encouraged with identifiable risk. In New York City (NYC), residents aged ≥65 accounted for 2% of new HIV diagnoses in 2010. However, 47% of them were diagnosed late in the course of infection, more than double the general NYC population (22%). We reviewed data from a 2011 survey on NYC residents' HIV testing behavior to assess the impact of CDC recommendations on older residents. Methods: A random telephone survey of NYC adults was conducted from June-August 2011. The survey collected information on demographics, HIV testing behavior, healthcare use, and sexual risk behavior. Results: Overall, 2,473 NYC residents completed the survey; 619 (25%) were aged ≥65 years, with 322 (13%) aged 65-74. Among those 65-74 years, 34% had sex within the last 12 months and 58% were never tested for HIV. Of those never tested, 93% saw a healthcare provider in the prior 12 months. Only 3% of them were offered an HIV test at their last healthcare visit, although 77% of respondents aged 65-74 said they would test on their healthcare provider's recommendation. Conclusions: Survey data from NYC residents aged 65-74 years suggest missed opportunities for HIV screening and case finding. Expansion of CDC recommendations to include those aged 65-74 could increase the number of older NYC residents tested by an estimated 214,000 and decrease late HIV diagnoses among this population.