A recent study has uncovered significant disparities in HIV testing practices in Spain, revealing that women and older adults are often underdiagnosed. Conducted by researchers from the Centre for Epidemiological Studies on HIV/AIDS and STI of Catalonia (CEEISCAT) and IDIAPJGol, the study analyzed data from over 5.8 million people attending primary care in Catalonia between 2017 and 2021. The findings, published in Eurosurveillance, show that only 22.7% of patients diagnosed with an HIV indicator condition (IC) received an HIV test within four months, highlighting a critical gap in early detection and treatment.
The study’s results indicate that implicit biases may be influencing clinical practices, with significant differences in testing rates based on gender, age, and migrant status. Men were more likely to be tested than women (26.3% vs. 19.4%), and younger individuals were tested more frequently than those over 50 (29.2% vs. 13.7%). Additionally, migrants had higher testing rates compared to Spanish nationals (27.7% vs. 21.3%).
Disparities in Testing Practices
The research highlights the conditions most likely to prompt an HIV test, such as syphilis (68.4%), genital herpes (50.6%), chlamydia (48.2%), and gonorrhea (43.1%). However, other conditions linked to HIV, like herpes zoster and seborrheic dermatitis, often went unnoticed. This discrepancy underscores the need for improved awareness and training among healthcare professionals.
Geographical disparities further complicate the issue. In the Barcelona region, 28.6% of cases with indicator conditions were followed by an HIV test, compared to less than 15% in rural areas such as Terres de l’Ebre or Alt Pirineu i Aran. These differences may reflect inequalities in resources, training, or access to diagnostic services, particularly in less urbanized settings.
Expert Insights and Recommendations
According to Dr. Cristina Agustí, a key researcher involved in the study, “the study highlights how implicit biases can influence clinical practice and perpetuate health inequalities. Specific training initiatives and clear protocols are needed to ensure that all individuals with HIV indicator conditions have equitable access to testing.”
The study calls for targeted interventions to improve adherence to international recommendations, ensuring systematic HIV testing in response to indicator conditions. This is particularly crucial for underdiagnosed populations, including women, older adults, and those in rural areas. Training healthcare professionals to recognize indicator conditions and adhere to protocols is essential, as is the introduction of tools to reduce implicit bias, such as electronic alert systems to prevent missed opportunities for diagnosis.
Towards Global Health Goals
These actions are vital to advancing towards the UNAIDS 95–95–95 targets for 2030, which aim for 95% of people living with HIV to be diagnosed, 95% of those diagnosed to receive treatment, and 95% of those treated to achieve viral suppression. Achieving these targets is crucial for controlling the HIV epidemic and ensuring equitable healthcare access across all demographics.
The study’s findings serve as a call to action for healthcare systems to address these biases and disparities, ensuring that all individuals, regardless of gender, age, or location, have access to timely and effective HIV testing and treatment. As Spain and other countries work towards these goals, the lessons from this study could inform policy changes and healthcare practices worldwide.
More information: Cristina Agustí et al, Implicit bias in HIV testing based on indicator conditions in primary care: a population-based study in Catalonia, Spain, 2017 to 2021, Eurosurveillance (2025). DOI: 10.2807/1560-7917.ES.2025.30.24.2400585