Washington, DC’s suburban efforts to combat HIV/AIDS lag behind the city’s outreach and prevention programs, according to a study funded by the Washington AIDS Partnership and Kaiser Permanente. The Washington Post reports that this study is the suburban version of a 2005 assessment of DC’s HIV/AIDS response.

“Nobody’s really looked at the suburbs,” said Emily Gantz McKay, president of Mosaica: The Center for Nonprofit Development and Pluralism, which authored the study. “There tends to be a big focus on central cities.”

The jurisdictions in the study were Montgomery, Prince George, Arlington, Fairfax, Loudoun and Prince William counties—including the city areas of Alexandria, Fairfax, Falls Church and Manassas.

Researchers recommended that local governments bolster testing by ensuring that HIV tests become a part of routine medical visits unless people opt out. The authors also suggested improving sex education in suburban schools.

“In many jurisdictions, teachers are visibly uncomfortable talking about sex,” McKay said. “If it’s going to change, parents in those jurisdictions would have to get involved with the schools.”

According to the study, 46 percent of the region’s 17,000 people who have received an AIDS diagnosis live in the suburbs while 54 percent live in the district. In addition to those diagnosed with AIDS, 13,000 people in the DC area are HIV positive.