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The US HIV Epidemic: Firm Foundations in HIV Screening, Prevention, and Treatment
CME/CE Information

Activity

Progress
1 2 3
Course Completed
Activity Information

Pharmacists: 0.25 contact hour (0.025 CEUs)

Physicians: maximum of 0.25 AMA PRA Category 1 Credit™

Nurse Practitioners/Nurses: 0.25 Nursing contact hour

Released: January 08, 2026

Expiration: January 07, 2027

Siham Mahgoub
Siham Mahgoub, MD

The US HIV Epidemic: Firm Foundations in HIV Screening, Prevention, and Treatment

 

[00:00:02]

 

Title slide: The US HIV Epidemic: Firm Foundations in HIV Screening, Prevention, and Treatment

 

Dr. Siham Mahgoub (Howard University Hospital): Okay. Hello, everyone. I'm Dr. Mahgoub from Howard University and associate professor of medicine in the College of Medicine. I'm also the medical director for the Center for Infectious Disease Management and Research in our clinic. It's my pleasure to collaborate with Clinical Care Options in these modules. The first module I'm going to present to you is the US HIV Epidemic: Firm Foundations in HIV Screening, Prevention, and Treatment.

 

[00:00:55]

 

slide: Faculty

 

So I have no disclosures, no relevant financial relationship or relationship to products or devices that have within eligible companies related to content of this educational activity.

 

[00:01:11]

 

slide: Learning Objectives

 

So the learning objectives is to apply CDC recommendations for HIV testing across clinical settings.

 

[00:01:20]

 

slide: Case 1

 

we have case one, which is a 30-year-old black woman at the primary care visit who comes in for annual exam and health maintenance testing. She's married. She has no evidence of previous HIV testing in the electronic health record, and no plans to have children.

 

So in this case, should there be - should we offer this woman an HIV test at this visit?

 

slide: Discussion: Is This Individual Part of a High-risk Demographic for HIV?

 

[00:03:55]

 

Is this individual that we have discussed part of an HIV risk demographic for HIV? So I want to bring to your attention the CDC  graph from 2022 for HIV diagnoses in the US, six territories, and freely associated states by race, ethnicity, and sex. So if you can see on the left-hand side, it's higher among Black/African-American men, about 36%. And also in women, it's highest among Black/African women compared to Hispanic, Latino, White, Multiracial, Asian, American-Indian, Alaskan Native or Native Hawaiian or other Pacific island. 

 

But also I want to bring to your attention is that in 2022, 15% of new HIV infections were attributed to women reporting heterosexual contact. So if you remember, that case we just discussed is, she was a woman. She was married. And, so there is a risk. There can be risk of new infection in women who have heterosexual contact.

 

slide: Discussion: Does It Matter if She Is Part of a High-risk Demographic for HIV?

 

So does it matter if she's part of a high-risk demographic for HIV? So the CDC recommendation for universal opt-out testing all patients between the age of 13 and 64 should be tested for HIV at least once as part of their routine health care. So patients who may have ongoing risk factors for HIV should be screened at least annually. The key reasons for universal opt-out testing recommendations. We want to reduce the stigma. We want to normalize HIV testing. It should be a normal test offered in primary care clinics. It also will facilitate earlier diagnosis and treatment and will prevent missing people because of risk bias.

 

slide: HIV Testing Is Important in Nearly All Healthcare Settings

 

So HIV testing is important nearly all healthcare settings. There are - because many unknown variables can affect the risk for HIV acquisition. The partner may have multiple other partners. The partner may be bisexual and have sex with men. So in that question, that woman, although she's married, she's in a monogamous relationship, but we don't know the history of her partner. So the key point is that this information is not needed to offer testing. So you don't need to know about their risk for HIV acquisition. True. If a patient comes to you, they have high risk for HIV acquisition. You go ahead and test them. 

 

But we won't - we don't want to make that a factor for us to provide HIV testing. So even providers who are not experienced in HIV care can offer testing. So it doesn't have to be just at the [?] Clinic because we are the HIV or the infectious diseases experts. This has to be normalized and be in other primary care settings.

 

slide: Case 1: Key Points

 

So let's summarize the key points for case one. The patient did not seem to have risk factors for HIV. She may have had a known risk for exposure likely needed to a prompt to think about getting an HIV testing. She was unlikely to go to an STI clinic where she should - where - where she would see literature suggesting HIV testing. So HIV testing is recommended for this patient, according to the CDC opt-out approach to decrease stigma and promote earlier diagnosis and treatment.

 

slide: Case 2

 

So we have another case. This is case two. This is a 63-year-old transgender man who comes to the ER in a rural Alabama hospital with chest pain. The ER system includes a regular prompt for offering all individuals an HIV test during workup. One of your colleagues in the ER suggests that you can skip offering an HIV test because this patient is elderly and he's 63 years old.

 

slide: Older People Are Less Likely to Be Tested for HIV

 

So older people are less likely to be tested for HIV. So older people are often perceived as being at low risk of HIV acquisition. The signs and symptoms of HIV may be mistaken for age-related conditions or other disease states. Older people may not want to be tested for HIV again because of stigma or negative personal feelings. But in 2021, the data shows that 34% of people who are older than 55 in the US who receive the diagnosis of HIV had already progressed to late-stage HIV/AIDS.

 

[00:07:34]

 

slide: Transgender People Face Barriers to Care

 

So there are a lot of barriers to transgender people. They face barriers in the healthcare setting. There is transphobia. There is HIV related stigma. There is institutional discrimination, a lack of provider knowledge. Luckily, here at Howard, we do care for everyone and no - no discrimination. In 2022, transgender people accounted for 2% a total number of 928 of 37 - around 37,000 new HIV diagnoses. Among transgender people, the majority, the total 869 of new diagnoses were among transgender women

 

slide: The South Accounts for ~50% of All New HIV Infections in the US

 

So the rates of HIV vary according to geography. If you remember in that case, we gave you that this patient was, you know, going to the ER in rural Alabama. So he's from the South. So, estimated HIV infections in the US by region in 2022, again from the CDC. Nearly half, 49% of new HIV infections were in the South, as you can see here illustrated in this diagram.

 

slide: Case 2: Key Points

 

So the key points, the take-home points are this patient is a candidate for HIV testing based on CDC opt-out recommendations based on his age. The patient's specific consideration older people are more likely to have advanced stage HIV at diagnosis. Transgender people face barriers to HIV care. The Southern region of the US has the highest rate of HIV.

 

slide: CDC Recommends Universal “Opt-out” HIV Testing

 

So the - again, the take-home message is the CDC recommends universal opt-out HIV testing all patients who are aged 13 to 64. So when? So it's who, when, and why? So who it's all patients aged 13 to 64 years. So if you remember, that patient was 63 years old. When? They should receive testing at least once as part of routine health care, at least annually for patients with ongoing risk factors. Why? This will allow us to promote early HIV infection and treatment, allows us to decrease stigma related to HIV testing and reduce HIV transmission.

 

Dr. Mahgoub:  I think if someone never had an HIV test, even though the CDC says 13 to 64, I think it's prudent to offer that testing again. Because going back to these patients have, you know, there is concern, there is stigma around being tested, and then you can dig deep. And sometimes in their first visit in primary care, they might not disclose all their exposures. They might have multiple partners. They might be bisexual. They might be homosexual. So they don't,  you know, give all their, you know, risk factors. So I think it's something to be offered, and we ask more, more questions.

 

slide: Go Online for More CCO Coverage of HIV!

 

So, go online for more coverage of HIV. There are on-demand fast-track modules, which feature clinical scenario - scenarios to learn HIV management principles. Download the slide sets for reinforcing concepts. Clinical thought featuring expert faculty perspectives, and thank you.