Health officials say more widespread testing for HIV is one of the keys to curbing the epidemic. They say testing is also the gateway to proper care and treatment.
Even so, many sexually active people don't know their status.
No country in the world has been harder hit by HIV than Swaziland. In this small, land-locked nation in Southern Africa, one out of four adults is infected.
Lungwile Dlamini is a community health worker in Swaziland.
She says people are aware of the high rate of HIV in her country, but are still reluctant to get tested.
"Mostly it's the fear of stigmatization, and also there's fear of being victimized by their in-laws," Dlamini says. "You have women who are chased away from their families just because they've tested positive, even if maybe it's the husband who actually brought the HIV into the family."
That level of discrimination isn't the norm here in the United States. So why isn't HIV testing more widespread?
"We have to bring it out in the open, make it not a fearful thing to get a test," says Terri Ford. "This is about health care. This is about people's lives."
Ford is with the Los Angeles-based AIDS Healthcare Foundation. It's the nation's largest community-based treatment provider.
Ford says Americans must change their attitude about HIV, and think about it as a disease like cancer or diabetes. She argues health care providers should make it easier to get tested.
"HIV testing should be streamlined to be as convenient and accessible as possible, for the person that is getting the courage up to get an HIV test," Ford says.
That's the philosophy behind San Diego County's mobile HIV testing unit.
"As soon as you're done fillin' it out," says Heidi Aiem, "just let us know and we'll get you up in there, so that we can get you tested."
On a weekday afternoon in Balboa Park, Aiem welcomes a client.
Aiem manages the county's testing and counseling services. Today she's overseeing the portable HIV testing unit, housed in a discreetly marked RV.
"If you walk inside of this door, watch your step on the bottom, and walk up into the unit," Aiem says, offering a tour. "You end up in the kind of multi-use space, and in this area we actually run all of our HIV tests. We do rapid testing, so clients get their test results within 20 minutes. And we have two exam rooms that are set up to do HIV counseling, and blood draws."
The testing and counseling are free.
The rapid test requires only a swab of a person's mouth. If the results are negative, that's the end of the process. If the results are positive, a follow-up test is done with a blood sample. Then, clients will be given referrals for support services and treatment.
"We're not getting people who are just concerned about the risks they're taking," Cunningham says. "They're waiting til they physically get ill, and that means that they're well along in the disease process."
That's especially true among African-Americans, who have the highest rate of AIDS in San Diego County.
Acintia Wright is on the County's HIV Planning Council, and founded Woman 2 Woman, the area's only HIV support group for African-American women.
She says in general, the level of knowledge about HIV is low among blacks.
"They also still have this fear of getting tested, people would rather not know," Wright says. "The stigma is still very attached to HIV, and they would rather not be associated with the stigma."
The County's Heidi Aiem says that what keeps people from testing is their misperception of their own risk.
"I think many, many people just do not perceive that they have any HIV risk at all," says Aiem.
And that's a dangerous attitude.
The Centers for Disease Control says one out of five Americans living with HIV is unaware of their status. The agency says these people are responsible for about half of all new infections.
