U.S. Recommends Routine Testing For the AIDS Virus
Friday, September 22, 2006
All adolescents and adults should routinely be tested for HIV infection in hospitals, clinics and doctors' offices, the federal government said yesterday, signaling a radical shift in the public health approach to the 25-year-old epidemic.
Under the new recommendations from the Centers for Disease Control and Prevention, patients would no longer have to sign a consent form and get extensive pre-test counseling. But they would have to be told they were being tested for the AIDS virus, asked if they have any questions and given the opportunity to "opt out."
The policy is a huge change from an era when stigma and fatalism led to a unique and -- in the opinion of some practitioners, onerous -- set of procedures for HIV testing.
"This represents a milestone for CDC and for our national health protection," Julie L. Gerberding, the CDC's director, said in a telephone news conference.
Universal HIV testing is part of an all-out effort to address three problems that many experts view as scandalous: 250,000 Americans are infected with HIV and do not know it, 40 percent of infected people are diagnosed when their infection is already at an advanced stage, and the number of new infections annually in the United States has not declined in 15 years.
If medical providers go along, the strategy may be able to reduce the number who do not know they are infected by two-thirds. Because many of those people are highly likely to pass the virus on -- either because of their behavior or because they are in an early stage of the disease, when more virus is in their bloodstream -- that could in turn help prevent new cases.
By rolling an HIV test into routine blood testing to measure blood sugar, kidney function, hemoglobin count and myriad other health indicators, the policy would make AIDS unique in another way. It would become the only infectious disease tested for more or less automatically in medical encounters. Pregnant women are tested for AIDS, syphilis and hepatitis B, but the CDC policy would cover everyone 13 to 64 years old.
Advocates for AIDS patients generally lauded the new strategy but expressed concern that it could lead to occasions when people are not told they are being tested or are not prepared to handle the results.
"It's all in the implementation," said David Munar, associate director of the AIDS Foundation of Chicago. "I am concerned that in some settings that patients will be shortchanged."
Marjorie J. Hill, executive director of Gay Men's Health Crisis in New York, said her organization agrees "that HIV testing needs to be expanded and that the procedures need to be streamlined as far as possible." But she added: "It is also important that the individual who is the object of these procedures and information have meaningful, informed consent. For some people that may be a two-minute conversation. In others it may take longer."
Between 16 million and 22 million HIV tests are done each year in the United States. CDC officials would not speculate on how much that might increase.
Newly identified cases of HIV are reported to local health departments in most states, and under another CDC policy they will soon be reported in all. That allows public health officers to help get those people into care and in some cases to trace sexual contacts.