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Sex differences in HIV testing in Catalan emergency departments
Neus Robert1,2, Emília Miró2,3, Jordi Llaneras2,4
1Emergency Department, Hospital Universitari Germans Trias i Pujol, Badalona.
Summary
Men were twice as likely to receive HIV testing compared to women in Spanish emergency departments. This sex-based disparity in HIV testing persists across all ages and settings, requiring urgent investigation.
Area of Science:
- Public Health
- Epidemiology
- Infectious Disease
Background:
- Undiagnosed Human Immunodeficiency Virus (HIV) infection is a key factor in viral transmission within Western nations.
- The existence of a systematic, sex-based bias in physician-ordered HIV testing is not well-established.
- Emergency departments (EDs) are critical points for identifying undiagnosed infections.
Purpose of the Study:
- To investigate potential sex-based disparities in HIV testing frequency among women and men in emergency departments.
- To compare HIV testing rates between sexes within specific diagnostic groups and across various institutional settings.
Main Methods:
- Retrospective analysis of 1.8 million emergency department visits across 11 sites in Catalonia, Spain.
- Data collection included patient sex, age, HIV test orders, and specific diagnoses (community-acquired pneumonia, herpes zoster).
- Statistical comparison of HIV testing rates between women and men, adjusting for age and hospital/ED characteristics.
Main Results:
- Women constituted 55% of ED visits but received only 38% of the 11,250 HIV tests ordered.
- Women had significantly lower HIV testing rates (0.43%) compared to men (0.86%), with an odds ratio of 0.50.
- This disparity was consistent across all age groups and hospital types, including specific diagnoses like pneumonia and herpes zoster.
Conclusions:
- A consistent, sex-based disparity in HIV testing by emergency physicians was identified, with women being tested less frequently than men.
- This bias was observed irrespective of patient age or the type of healthcare setting.
- The underlying reasons for this disparity are unknown and necessitate immediate research and intervention.
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