Less than 1% of visits to the emergency room in 2019 and 2020 included an HIV test, according to findings published in the February 2024 issue of AIDS. This is despite the federal recommendation that people in health care settings should be tested for HIV unless they decline (referred to as opt-out screening).

What’s more, compared with other U.S. regions, the South saw the lowest rates of HIV testing in ER settings: 0.6% in 2019 and 0.5% in 2020. Compared with metropolitan areas, rates in the more rural South were even lower (0.1% or less each year).

This is notable because for several years, the South has been the epicenter of our nation’s HIV epidemic, particularly for people of color. In 2021, the South comprised 38% of the U.S. population but 52% of new HIV diagnoses, according to data from the Centers for Disease Control and Prevention (CDC).

Several factors contribute to higher HIV rates in the South, including poverty, unemployment, stigma, lack of access to care in rural areas and a lag in testing, treatment and education. In addition, many Southern states have not expanded Medicaid, the health insurance program for low-income and disabled Americans that is the largest source of health coverage for people living with HIV in the United States.

In addition, the CDC estimates that around 14% of the 1.2 million people living with HIV nationwide do not know they carry the virus, and nearly 40% of new HIV cases are transmitted by people who don’t know their status.

Thus, failing to test people for HIV when they are at the ER is a missed opportunity to diagnose and connect folks to care, since it is well established that emergency departments can offer vital access to HIV services.