Health system barriers to HIV and STI diagnostics uptake in the United States: A comprehensive review

Public health efforts spanning several decades have failed to increase testing rates for HIV and sexually transmitted infections (STIs) throughout the United States, resulting in ongoing transmission and delayed diagnosis of these diseases. Testing rates have declined substantially due to multiple barriers within health systems, including structural, institutional, provider, and patient-level factors. Primary care and emergency department facilities face operational difficulties, including insufficient staff, limited appointment durations, and the absence of organized testing procedures. Implementing screening guidelines is hindered by provider knowledge gaps, discomfort with sexual health histories, and clinical inertia. Existing policies and reimbursement limitations restrict testing service capacity, creating financial disparities and complicated billing systems. Patient-related barriers, such as concerns about confidentiality, stigma, and accessibility, disproportionately affect marginalized populations, including racial and sexual minorities, adolescents, and residents of rural or underserved regions. The current healthcare system fails to provide integrated HIV and STI testing services, creating a significant gap in service delivery. Emerging strategies such as self-testing, at-home STI kits, nurse-initiated screening, electronic health record prompts, and enhanced reimbursement models demonstrate potential to increase uptake but require broader implementation to be effective. Addressing these obstacles requires a combination of policy changes, institutional backing, educational programs for healthcare providers, and patient-focused advancements. Expanding HIV and STI testing services is an essential first step for early disease identification, patient treatment initiation, and transmission control efforts that support national health objectives.