NURS 503 Week 2 Healthy People Health Indicator Overview Paper Example

Thirteen in a Hundred Still Do Not Know: An Overview of the Healthy People 2030 Leading Health Indicator on Knowledge of HIV Status

In 2022, about 87 of every 100 people living with HIV in the United States knew they had it. The remaining 13 did not, and because they did not know, they could neither start treatment nor take steps to protect partners. Healthy People 2030 names knowledge of HIV status as one of its leading health indicators, the small set of objectives chosen to drive action on the nation's most important health problems. This paper describes the indicator and its data, explains why it matters for population health, examines its determinants and the populations most affected, and considers the role of nurses in moving it toward its target.

The Indicator

Objective HIV-02 aims to increase knowledge of HIV status among people aged 13 years and older who are living with HIV (Office of Disease Prevention and Health Promotion [ODPHP], n.d.). It is designated a leading health indicator. The baseline was 85.8% in 2017, the target for 2030 is 95.0%, and the most recent value, for 2022, is 87.2%, a change the Healthy People tracking system classifies as improving. The 95% target matches the first of the international 95-95-95 goals, under which 95% of people with HIV know their status, 95% of those diagnosed receive treatment and 95% of those treated achieve viral suppression.

The indicator measures something that cannot be counted directly. Because people who do not know they have HIV have not been diagnosed, the figure is an estimate built from surveillance data on diagnoses, the stage of infection at diagnosis and models of how long infection goes undetected (Centers for Disease Control and Prevention [CDC], 2024). That method means the indicator is reported with a lag of several years.

Trends and the Size of the Gap

A gain of 1.4 percentage points in five years is real progress, but it is slow relative to the target. Moving from 87.2% to 95% would require diagnosing most of the remaining undiagnosed population by 2030. Expressed in people rather than percentages, the gap matters more: with roughly 1.2 million people living with HIV in the United States, each percentage point represents about 12,000 people. A national indicator that looks nearly complete at 87% still describes well over a hundred thousand people who have not yet been told.

Why the Indicator Matters

Knowledge of status is the first step on the HIV care continuum, and every later step, entering care, starting antiretroviral therapy and reaching viral suppression, depends on it. People who achieve and maintain viral suppression have effectively no risk of transmitting HIV through sex. CDC modeling of transmission in 2016 found that people who were unaware of their infection, whether recently or longer infected, generated about 38% of all new transmissions, and that transmission rates were highest among those acutely infected and unaware (Li et al., 2019). In population terms, earlier diagnosis ranks among the strongest levers for cutting new infections, and it is also what allows each person to begin treatment that preserves their health.

Determinants

Individual Factors

Many people who have HIV do not consider themselves at risk, and some avoid testing because of fear of the result or of how others would treat them. Stigma attached to HIV and to the groups most affected by it remains a barrier to seeking a test.

Health System Factors

Testing depends on being offered a test. For years HIV testing in health care settings required separate written consent and pre-test counseling, which made it slow and easy to skip. In 2006 the CDC recommended routine opt-out HIV screening for patients aged 13 to 64 in all health care settings, with separate written consent and prevention counseling no longer required as part of routine screening (Branson et al., 2006). Federal prevention guidance later went further, recommending that adolescents and adults between 15 and 65 be screened, along with younger or older people at increased risk (U.S. Preventive Services Task Force, 2019), a grade A recommendation that requires most health plans to cover screening without cost sharing. In practice, many clinicians still test only when a patient appears to be at risk, which misses people who do not disclose or do not recognize risk.

Policy and Community Factors

State laws, health insurance coverage, the availability of free community testing and the presence of emergency departments and clinics that offer routine screening all shape the indicator locally. The population health perspective in the course text emphasizes that such factors, operating across sectors, often matter more than individual choices (Nash et al., 2016).

Populations Most Affected

The national figure hides large differences. Adolescents and young adults have the lowest awareness of any age group: in 2022 about 56 of every 100 people aged 13 to 24 with HIV knew their status, although that was an improvement from about 42 in 2018 (CDC, 2024). Young people with HIV are also less likely than older adults to have a regular source of care where a test would be offered. Differences by race and ethnicity, sex and region reflect differences in access to care, stigma and testing practices, and the South carries a large share of new diagnoses. A program to improve the indicator must therefore look beyond the national average to the groups and places where awareness is lowest.

From Diagnosis to Care

Knowing one's status matters only if it leads to treatment, so any effort to raise the indicator must be paired with reliable linkage to HIV care. The modeling by Li et al. (2019) found that people who knew they had HIV but were not in care generated the largest share of transmissions, about 43%, which shows that a diagnosis without linkage adds little to population health. For a clinic or emergency department, that means a positive screening result should trigger a defined sequence: confirmation testing, disclosure by a trained clinician, an appointment with an HIV provider, often within days, and follow-up to confirm the patient attended. Programs that measure only the number of tests performed can look successful while patients are lost between the result and the first visit.

Measuring Progress Locally

The national indicator is reported years after the fact and cannot show whether a local program is working. A health system or health department that wants to move the indicator needs its own measures, such as the proportion of eligible patients offered a test, the proportion who accept, the number of new diagnoses and the proportion of new diagnoses linked to care within 30 days. Nash et al. (2016) describe measurement as central to population health management, because a defined population can be tracked over time in a way that individual encounters cannot. These process and outcome measures will form the evaluation plan for the intervention project later in this course.

The Nurse's Role

Nurses are present at nearly every point where a test could be offered: emergency departments, primary care, urgent care, prenatal care, school-based clinics and community programs. Advanced practice nurses can make routine opt-out screening part of standard care in their practices, build reminders into the electronic record, and ensure that every positive result leads to a confirmed linkage to HIV care. Nurses also shape whether testing feels routine or stigmatizing, through the words they use when offering it. In public health and community roles, nurses can support testing outreach for young people, who are least likely to know their status, through school-based clinics, college health services and community events where testing is offered alongside other routine care. Nurse educators, finally, can prepare new nurses to offer a test as plainly as they offer a blood pressure check.

A Christian Perspective on Stigma

The Gospels describe Jesus responding to a man with leprosy, a condition that brought exclusion from community life, by stretching out his hand and touching him (English Standard Version Bible, 2001/2016, Mark 1:40-41). The touch came before the healing and communicated that the man still belonged. For nurses, offering HIV testing to every patient as a routine part of care, rather than singling out those who seem to be at risk, is one way of removing the shame that keeps people from being tested, and it reflects the same refusal to treat anyone as untouchable.

Conclusion

Knowledge of HIV status is a leading health indicator because diagnosis opens the door to treatment and prevention. The national figure has improved from 85.8% to 87.2% but remains well short of the 95% target, and awareness among young people is far lower. Routine opt-out screening, attention to the groups with the lowest awareness and reliable linkage to care are the most direct ways nurses can help close the gap, and they set the direction for the intervention project later in this course.

References

Branson, B. M., Handsfield, H. H., Lampe, M. A., Janssen, R. S., Taylor, A. W., Lyss, S. B., & Clark, J. E. (2006). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recommendations and Reports, 55(RR-14), 1-17.

Centers for Disease Control and Prevention. (2024). Estimated HIV incidence and prevalence in the United States, 2018-2022 (HIV Surveillance Supplemental Report, Vol. 29, No. 1). https://www.cdc.gov/hiv-data/nhss/estimated-hiv-incidence-and-prevalence.html

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Li, Z., Purcell, D. W., Sansom, S. L., Hayes, D., & Hall, H. I. (2019). Vital signs: HIV transmission along the continuum of care, United States, 2016. Morbidity and Mortality Weekly Report, 68(11), 267-272. https://doi.org/10.15585/mmwr.mm6811e1

Nash, D. B., Fabius, R. J., Skoufalos, A., Clarke, J. L., & Horowitz, M. R. (2016). Population health: Creating a culture of wellness (2nd ed.). Jones & Bartlett Learning.

Office of Disease Prevention and Health Promotion. (n.d.). Increase knowledge of HIV status: HIV-02. Healthy People 2030. U.S. Department of Health and Human Services. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/sexually-transmitted-infections/increase-knowledge-hiv-status-hiv-02

U.S. Preventive Services Task Force. (2019). Screening for HIV infection: US Preventive Services Task Force recommendation statement. JAMA, 321(23), 2326-2336. https://doi.org/10.1001/jama.2019.6587