By Finn, Robert
Clinical Psychiatry News , Vol. 34, No. 11
The Centers for Disease Control and Prevention has recommended that voluntary HIV screening be a routine part of medical care for all patients between the ages of 13 and 64 years.
The recommendations are intended to simplify the HIV testing process in health care settings and to increase HIV diagnosis among an estimated 250,000 Americans who are HIV positive but remain unaware of their infection.
"There are some things that never should happen," Dr. Julie L. Gerberding, the CDC's director, said during a press briefing. "No child in the United States should be HIV infected from birth. No person in the United States should [lack] access to treatment or diagnosis. And ultimately no person in the United States should acquire HIV infection."
Studies show that almost 40% of individuals diagnosed with HIV receive that diagnosis within a year of the infection progressing to AIDS, and presumably about 10 years after they were initially infected. Often, this is too late for them to fully benefit from treatment.
Furthermore, it is estimated that people who are unaware of their infection account for 50%-70% of new sexually transmitted HIV infections. People who are aware of their HIV infections typically take steps to protect their partners.
The recommendations, published in September, are intended for any health care facility in the public or private sector that currently conducts diagnostic testing or screening. These facilities include hospital emergency departments, urgent care clinics, inpatient services, substance abuse treatment clinics, public health clinics, community clinics, correctional health care facilities, and primary care settings (MMWR 2006; 55: No. RR-14).
The new recommendations do not apply to nonclinical settings, such as community centers or outreach programs.
Earlier recommendations, published in 1993 and 2001, called for HIV testing in patients with known risk factors or in communities with HIV prevalence rates above 1%.
But many facilities do not have information on local HIV prevalence, and many providers report that they do not have time to conduct risk assessments.
Requirements for separate written consent for HIV testing and for pretest counseling also placed barriers in the path of testing.
The new recommendations mandate a voluntary "opt-out" approach, in which patients would be specifically informed that HIV testing is part of routine care. All patients would be screened regardless of risk, pretest counseling would not be required, and posttest counseling would generally be required only for patients with a positive test result. …