Even Modest Fees for HIV Tests May Present a Big Barrier to Treatment

For roughly another week, individuals in Mississippi will be able to get tested for HIV and other sexually transmitted infections at no cost. However, as of July 1st, the Mississippi State Department of Health (MSDH), due to budget cuts, will begin charging $25 at all of its clinics for individuals to have the tests and lab work done. Individuals age 18 and younger or who have been identified as a sexual contact of an infected individual will be exempt from paying.

As Mississippi has one of the highest rates of new HIV infections in the nation, this new fee structure does not bode well for the state’s—and indeed the entire region’s—substantial at-risk population. The Centers for Disease Control and Prevention (CDC) reports that since the beginning of the AIDS crisis, the epicenter of the disease has shifted from major coastal cities, such as New York and Los Angeles, to southern locales, which include not just cities, but suburban and rural areas. In fact, 44% of all people living with HIV reside in the South, and many of them are unaware that they harbor the virus.

The epidemic in Mississippi, as in much of the South, is fueled by factors such as poverty, lower levels of education, and inadequate access to healthcare. Some in the community now worry that these factors, combined with the disappearance of free testing, will halt any progress that’s been made toward increasing levels of remission and complete eradication of the disease.

“We’re very concerned about it,” Rob Hall, state director of The Human Rights Campaign in Mississippi, a civil rights organization focused on achieving equality for the lesbian, gay, bisexual, transgender, and queer community, told Contagion^®. “It’s creating a monetary barrier. Healthcare providers should always make HIV testing more accessible, not less. People need to be tested and tested quickly, and they shouldn’t have to jump through hoops to do that.”

For those who can’t afford $25 to be tested, the MSDH says there are a handful of community groups funded by the state, and possibly the CDC, that will offer free testing. Clinics will work with individuals’ incomes and possibly ask them to pay on a sliding scale. Individuals also can utilize the Ryan White HIV/AIDS Program, a government program that provides primary medical care and support services for uninsured or underinsured individuals living with HIV. Right now, the program offers care and treatment to more than 500,000 individuals a year, or slightly more than half of those who’ve been diagnosed in the United States.

Hall is not convinced that efforts such as these will be enough to cover testing for everyone who needs it once the $25 fee goes into effect, and therefore, he and his team have been working with local healthcare providers to raise awareness. “We’re calling on our state officials to reverse this and be in the forefront,” he says. “The people in power are the ones who need education around these issues.”

The barriers to testing and treatment, however, are not always financial. Stigma remains a significant obstacle for many individuals, especially in African-American communities and particularly in the South. Oftentimes, individuals are reluctant to admit their sexual orientation to healthcare providers because of homophobia and other negative attitudes.

“Stigma is one of the most difficult barriers we face,” James Stewart, PhD, MBA, Director of the Office of STD/HIV at the MSDH, told Contagion^®. “We work with community groups to educate people about HIV. We have also funded media campaigns, patient navigators, and a free app—Your PSH—to educate and spread awareness. The Mississippi HIV Planning Council meets quarterly to work on programs to reduce stigma.”

This stigma, in addition to the difficulty of coming up with $25 each time a test is needed (Mississippi has a per capita income of slightly more than $21,000 per year, the lowest in the nation), means testing may be even further out of reach for those who most need it.

Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.