Sex differences in HIV testing in Catalan emergency departments

Undiagnosed HIV infection remains a major driver of viral transmission in Western countries. Whether a systematic sex-based bias exists in HIV test ordering by physicians is unknown. We aimed to analyze the frequency of HIV testing among women and men attending 11 emergency departments (EDs) in Catalonia, Spain.

We recorded the total number of ED visits and HIV tests performed, both overall and for two specific diagnoses included in an opt-in testing strategy: community-acquired pneumonia (CAP) and herpes zoster. Data on patients' sex at birth and age were retrieved from administrative records, along with hospital (large vs. medium-small, metropolitan vs. nonmetropolitan) and ED characteristics (high vs. nonhigh activity, with vs. without gynecological facilities). The primary objective was to compare HIV testing rates between women and men, overall and by diagnosis. Secondary analyses evaluated results by age strata and institutional characteristics.

A total of 1.8 million patients (55% women) attended the 11 EDs over a combined period of 335 months (median: 33 months per ED). During this time, 11 250 HIV tests were ordered (38% in women), averaging 34 tests per ED per month. Women were significantly less likely to be tested than men [0.43 vs. 0.86%; odds ratio (OR): 0.50, 95% confidence interval (CI): 0.48-0.52]. Among 31 515 CAP and 2990 herpes zoster cases, women also had lower testing rates (10.6 vs. 13.5% in CAP, OR: 0.76; 6.4 vs. 11.3% in herpes zoster, OR: 0.51). Results were consistent across all age groups and hospital/ED types.

We identified a consistent sex-based disparity in HIV testing by emergency physicians, with women less likely to be tested than men, regardless of age or institutional setting. The causes of this bias remain unclear and warrant urgent investigation and corrective action.