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Fewer than 40 percent of Americans have ever gotten HIV testing, according to a new report from the Centers for Disease Control and Prevention. These rates are even lower in states with rural areas where the disease is disproportionately more common.

The report is based on two years (2016-2017) of national survey data of adults living in areas where the majority of new HIV cases have been diagnosed in recent years. These areas include 50 counties across 20 states and Washington D.C., as well as seven states where rural rates of HIV have been especially high, including Alabama and Missouri. As part of the survey, volunteers were asked if they were screened for HIV in the past year as well as in their lifetime.

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From there, the authors estimated that only 10 percent of Americans had gotten HIV testing in the past year, while 38 percent had gotten it in their lifetime. Testing rates were higher among some groups thought to be higher risk for HIV, such as men who have sex with men. Counties where HIV was diagnosed more often generally had higher testing rates, too. But the lifetime rate was lower (35.5 percent) in the seven states with higher rural HIV prevalence.

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The study is all the more sobering because it’s these same areas that are being targeted by the federal government’s upcoming health initiative to dramatically reduce, if not fully eliminate, new cases of HIV by 2030. So right now, the outlook isn’t looking too rosy.

“These findings demonstrate missed opportunities to fully implement HIV screening recommendations in the 57 jurisdictions that will serve as the initial geographic focus of the Ending the HIV Epidemic initiative,” the authors wrote.

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HIV, of course, is no longer the death sentence it once was. We’ve gotten to the point that people with the disease live as long as everyone else, so long as they have access to antiretroviral therapy; these drugs can also drive levels of the virus so low as to make the disease impossible to transmit to others. And there have even been promising efforts in finding ways to fully cure the chronic disease in some people.

When it comes to ending the epidemic, though, finding a cure to HIV isn’t as impactful (or realistic right now) as simply preventing new cases. And we already have the tools well in hand to accomplish that feat in the near future. Safe sex practices, like condoms, are obviously important, but there’s also pre-exposure prophylaxis (PrEP), a medication that can significantly protect people at high risk for HIV from catching it.

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If people aren’t vigilant in testing themselves for HIV, though, efforts to contain and prevent the disease will remain undercut. It’s estimated that 1.1 million Americans over the age of 13 may have HIV currently, with as many as 14 percent of HIV-positive people unaware their status. Though untreated HIV can eventually lead to serious complications like AIDS and rare infections, many people initially have few or no obvious symptoms of the disease, which can often resemble the flu at first.

You don’t even need to be having sex to catch HIV. Because of that reality, the CDC recommends that people get regularly tested for HIV and other sexually transmitted infections if they’re between the ages of 13 to 64. People at higher risk for HIV, such as those who have had multiple or recently untested sex partners since their last HIV test, should get tested more often.

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