Knowledge is power: Testing everyone for HIV status

Two important facts come to mind when thinking about HIV testing:

• Right now, more than 250,000 Americans are believed to be living with HIV, unaware of their infections.
• Nearly 40% of people with HIV are diagnosed within a year of developing full-blown AIDS, when it may be too late to benefit fully from treatment.

These numbers underscore the continued urgency of the HIV/AIDS epidemic and point to a clear course of action to address it. After all, knowledge is power.

People need to know their HIV-positive status so they can protect themselves and their partners as well as have access to new life-extending treatments and therapies as early as possible to give them the best chance at a future.

These are the realities behind new Centers for Disease Control and Prevention recommendations for HIV testing in the health care setting. The guidelines are a step forward in controlling the spread of this deadly virus.

The CDC begins with a straightforward ask -- that HIV screening become a routine part of medical care for all patients between the ages of 13 and 64. The guidelines also include other provisions to streamline these efforts.

Previous recommendations, for instance, called for HIV testing in health care settings with high HIV prevalence -- above 1% -- and for all high-risk individuals. But physicians reported that such data often were not available and that time constraints made conducting risk assessments unwieldy.

Ultimately, the hope now is that the new approach, published in the Sept. 22 Morbidity and Mortality Weekly Report, will make widespread testing more practical and possible for busy medical practices.

According to the CDC, pretest counseling and separate, written informed consent is no longer necessary. Instead, consent should be incorporated into general consent for medical care. Patients also should be advised of the test and given the opportunity to opt out. Prevention counseling and ongoing care linkages should be provided for patients who are found to have the virus. Counseling continues to be encouraged for all patients where feasible, especially when the health care visit is related to substance abuse, sexual health, family planning or comprehensive assessments. This CDC framework was developed over three years with extensive input from public health experts, community-based groups, advocates and medical organizations.

The American Medical Association, for instance, views the new recommendations as an important public health strategy. The Association has long worked to increase office-based HIV testing to make inroads in the early diagnosis of HIV infection. And the effort to normalize HIV testing further will reduce its stigma. The AMA has pledged to join with the CDC to devise tools and offer guidance to enable physicians to begin implementing these approaches.

Granted, some physicians have expressed concern, saying these changes likely will result in lost opportunities for HIV counseling and education. But others maintain that conducting more tests is central to stopping HIV's transmission.

The problem is not going away. Though the annual number of AIDS deaths has declined substantially since 1994, the trend lines more recently have stabilized. Moreover, cases among African-Americans, other ethnic and minority populations, and people exposed through heterosexual contact have increased.

Still, now more than ever, hope exists in the fight against HIV and AIDS -- a true sea change from the perceptions that first surrounded it. Physicians should embrace this CDC effort. Additionally, states should re-examine their consent and counseling laws to ensure that physicians can carry out the new recommendations as soon as possible.

Twenty-five years and more than 529,000 American lives have passed since the beginning of this epidemic. Helping patients step away from the stigma and be aware of where they stand in terms of HIV status is a powerful strategy for saving lives.