Routine HIV Screening Health Care Assessment in Primary Care in Outpatient Clinics at Southern Puerto Rico

Background: Despite established guidelines recommending routine HIV screening for individuals aged 13 to 64 at least once in their lifetime, testing remains underutilized in many primary care settings. Puerto Rico faces a disproportionately high HIV burden, particularly in the southern region, yet limited data exist on screening adherence and patient awareness. This study aimed to evaluate the socio-demographic characteristics and sexual behaviors associated with routine HIV testing among adults in primary care clinics in southern Puerto Rico. Methods: An IRB-approved, retrospective cross-sectional study was conducted using a 20-item anonymous survey administered via REDCap. Participants (n=469) were adults aged 18 and older who accessed outpatient primary care services in southern Puerto Rico. The survey assessed HIV testing history, physician-patient communication, sexual behavior, and awareness of CDC guidelines. Results: A concerningly high proportion of participants (66.9%) indicated that their primary care physician had not educated them about HIV testing, and 82.7% reported never having been asked or referred for an HIV test. HIV testing was nearly evenly distributed (49.7% tested vs. 48.9% untested). The most cited reason for not being tested was a perceived lack of necessity (73.4%). Participants who had been tested (mean age: 56.32 years) and those willing to accept testing (mean age: 58.87 years) were significantly younger than their counterparts (p<0.001). Sexual activity in the past year was strongly associated with prior HIV testing (p=0.005) and willingness to be tested (p=0.002). Awareness of CDC screening guidelines (45.4%) and the availability of free testing centers (40.1%) was low. Conclusion: Findings underscore the need to improve physician engagement and HIV education in primary care. Age, sexual activity, and perceived need significantly influenced testing behaviors. Interventions targeting older adults and enhancing routine screening practices are critical to reducing HIV burden in Puerto Rico.