Mandatory Testing and Treatment Can End the AIDS Epidemic

By Sanford F. Kuvin
Monday, December 1, 2008

AIDS remains the world's No. 1 health threat and in the United States is a grave risk to black people in particular. As Phill Wilson, executive director of the Black AIDS Institute, put it, "AIDS in America is a black disease . . . about half of the just over 1 million Americans living with HIV or AIDS are black."

Yet the disaster of AIDS in black or white America does not have to be this way. While a cure is still years away, a nation with U.S. literacy rates and levels of cultural and public-health sophistication is capable of greatly reducing its number of new infections. So why are new AIDS cases, particularly among blacks in urban areas, outpacing gains in control, treatment or education among high-risk groups?

The answer lies in the unwillingness of the Centers for Disease Control and Prevention to adopt control measures, including routine mandatory testing among broad age groups. Any time blood samples are taken from U.S. residents ages 13 to 64, such as in an emergency room, physicians should have the right to scan for HIV. For those who don't regularly visit a doctor, blood tests could be scheduled, with the results recorded by states and the CDC. As The Post reported last week, a recent study in the Lancet concluded that such measures, accompanied by treatment for all those who are HIV positive, have the potential to end the AIDS epidemic in Africa within a decade. The effects are likely to be faster in this country.

When bird flu was a threat a few years ago, strict mandatory testing measures were implemented in high-risk areas, greatly reducing the threat of an epidemic. But unlike bird flu, which presents symptoms quickly, HIV can remain undetected for years. Because we do not test all risk groups, 20 to 40 percent of Americans who are HIV-positive are not even aware that they are infected, and they often pass on the virus. This alone significantly contributes to the epidemic among black Americans.

HIV is spread only by blood, sex, and needles and during pregnancy, but within those parameters, people are equally susceptible, regardless of gender, age, color or social status. So when the CDC, in a public policy about-face, recommended in 2006 that doctors offer HIV tests not just to high-risk patients but as part of routine medical care to everyone ages 13 to 64, it was a giant step forward. But nothing requires physicians to comply with this recommendation. And U.S. infection rates show that voluntary testing has failed to stem the tide of this disease.

Today not even pregnant women in America are regularly tested for HIV. They must ask to be tested, and it's understandable that few people are interested in receiving such potentially frightening information. Sadly, when a test is positive, there is no mandatory treatment or counseling for the patient, nor does federal law require that a patient's sexual partners be notified or tested.

All U.S. measures regarding HIV testing, treatment and tracing are voluntary -- a policy that has resulted in an increase in AIDS cases, many of which could have been prevented by simple public health initiatives. Blood testing should be mandatory once or twice a year when people visit a doctor's office or hospital. Testing already is mandatory in blood banks and the military, and it is a policy of many insurance companies. Other routine blood tests are done without patients' explicit permission when doctors deem it advisable; it should be the same with HIV.

It might surprise many to learn that the paradigm of excellent AIDS control can be found in Cuba, which discovered this sexually transmitted disease -- long before it was named -- among its soldiers when they returned from Angola in the 1960s. Mandatory testing, tracing and treatment brought that nation the lowest AIDS rate in the Western world.

To be clear: No Americans need to be quarantined for HIV/AIDS. But all citizens are entitled to the same public health protection under the law that is already afforded them against tuberculosis or bird flu.

Until we have universal testing and mandatory reporting, tracing and treatment, the government is failing to fulfill its obligation to protect the public health interests of America's uninfected, regardless of race or ethnicity. The United States has the opportunity to prolong uncountable numbers of lives and protect millions of others. America should choose to lead -- and leave behind its ineffective public health policy.

The writer is founder and international chair of the Sanford Kuvin Center for the Study of Infectious and Tropical Diseases at the Hebrew University Medical School in Jerusalem. He was medical counsel to Kimberly Bergalis, the first patient to have gotten AIDS from her dentist.

© 2008 The Washington Post Company