CDC urges more HIV testing
Pastor Dale Morgan
CDC: Make HIV tests part of routine medical care for all Americans 13-64*
Updated 9/22/2006
Under the new guidelines, patients would be tested for HIV as part of a
standard battery of tests they receive when they go for urgent or
emergency care, or even during a routine physical.
By Steve Sternberg, USA TODAY
AIDS virus testing should be offered regularly to everyone ages 13 to 64
in every hospital, doctor's office and clinic to speed diagnosis and
help curb the epidemic, federal health officials recommended Thursday.
The Centers for Disease Control and Prevention's recommendations are not
legally binding, but they are designed to make HIV testing as routine as
tests for high blood pressure, cholesterol and diabetes. About 1 million
people in the USA are HIV-positive, but 250,000 of them have not been
diagnosed, according to the CDC.
"It will allow us to identify a lot of people who have HIV and don't
know it," the CDC's Timothy Mastro says.
The guidelines no longer require health workers to provide special
counseling before and after the test, and they lift the requirement that
patients supply specific written consent, though patients must be given
the opportunity to refuse testing.
Daniel Kuritzkes of the University of Colorado, chair of the HIV
Medicine Association, says, "I think the guidelines will help
destigmatize HIV testing by making it part of routine medical care and
not a test with some special mystique about it."
More than a dozen AIDS advocacy groups released a statement objecting to
the decision to drop counseling.
"We fear that some health care settings will interpret today's
announcement as a call for universal screening and test patients without
informing them or arming them with the information they need to avoid
putting others at risk," says David Munar of the National Association of
People with AIDS.
Peter Staley, a founder of the protest group ACT UP, disagrees with his
peers: "The bottom line is that we're really losing the fight here.
We're losing lives. I'm an ACT UP grad, and our motto is 'by any means
necessary.'
"I realize that abandoning written informed consent raises issues.
People are worried about privacy and stigma. But the bottom line is that
this would probably save lives, and that's why I'm very much in favor of
it."
Even patients diagnosed late in the course of the disease can extend
their life expectancy by 14 years with standard treatment, according to
a recent study led by Rochelle Walensky of Harvard Medical School.
Patients diagnosed soon after infection can extend their lives by as
much as 25 years, she says.
Mastro says diagnosis is a powerful tool for prevention. "We think that
the quarter of a million people who don't know their infection status
account for 70% of sexually transmitted infections," he says. "We have
very strong data showing that when patients know they're infected, they
take strong measures to avoid infecting others."
Studies have shown that AIDS testing is as cost-effective as tests for
high blood pressure and colon cancer.
The new guidelines leave open two key concerns: who will pay for the
tests and the cost of treating 250,000 new HIV patients.
"The strain that this is going to place on Medicaid, the Ryan White Care
Act and the state AIDS drug assistance programs is going to be
enormous," says A. David Paltiel of Yale University, who has studied the
test's cost-effectiveness.