It’s difficult to keep a virus from spreading when you don’t know who has it. One of the main reasons HIV continues to be a problem, even in a developed country like the United States, is that 1 in every 4 HIV–positive Americans goes about life without having any idea he’s infected.
And these 250,000 or so undiagnosed people unknowingly cause another 20,000 new infections a year, according to the American College of Physicians (ACP).
That’s why the ACP issued a report on World AIDS Day, calling on U.S. doctors to test every single one of their patients over the age of 13. “Now there is enough evidence showing that routine HIV screening should be adopted,” says ACP member Amir Qaseem, MD, PhD. He says Americans should get used to checking their HIV status along with their cholesterol.
The old model of restricting the tests to so-called high-risk groups—gay men, African Americans, IV–drug users—is out the window (although the ACP says they should be tested more often).
So is the practice of asking patients whether they’ve engaged in behavior that spreads HIV, such as having unprotected sex with multiple partners or already having another sexually transmitted disease. “In the past, risk-based assessment hasn’t been successful,” says Dr. Qaseem. “People don’t really divulge their risk factors.”
The new ACP guidelines aren’t all that different from the guidelines issued by the U.S. Centers for Disease Control and Prevention (CDC) in 2006 urging doctors to include HIV tests in routine visits, except the CDC exempted communities where the prevalence of HIV was less than 0.1%.
“The CDC message is out there,” says Dr. Qaseem, “but it takes a while to catch on. We’re trying to send this message out to the interns because reinforcement really helps.”
Routine or universal testing is getting more and more support globally too. Last week, the World Health Organization announced the results of a computerized model that showed such testing would cut the number of people progressing from HIV infection to AIDS by 95%—if accompanied by full access to antiretroviral medications. Only about a third of those in need of HIV treatment worldwide have access to it now, says the WHO.
Opponents of routine testing argue: Why push for more test results if there are no drugs available to help those testing positive? It’s less of an issue in rich countries such as the United States, but a persistent problem in African countries, for instance.
Routine-testing critics have been especially irked that CDC and United Nations guidelines alike have stopped requiring that every HIV test have the patient’s written consent and be accompanied by a conversation to teach the newly diagnosed how to protect sex partners, find treatment, and handle anti–HIV discrimination.
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