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CDC to recommend HIV test for most Americans
By Greg Barr
The Daily News

Published May 21, 2006
More than 1 million Americans already live with HIV infection, and more than 40,000 more are exposed to the virus each year.

But according to the Centers for Disease Control & Prevention, most new HIV infections in the country are transmitted by the 25 percent of those carrying the virus who have no idea, or don’t want to know, they are infected.

CDC officials suggest that is the country’s biggest problem in fighting the spread of the virus. So the national health agency has come up with a solution.

In a position paper to be published this summer, the CDC will recommend that every person in this country between the ages of 13 and 64 should voluntarily have an HIV test as part of a routine blood screening, with no need for separate consent.

“Current HIV testing recommendations call for routine testing for those at high risk … however this process is not leading to adequate diagnosis of infection,” said CDC spokesperson Tammy Nunnally.

“When people learn they are infected, they take steps to protect their (sexual) partners. Knowledge of status can also mean easier access to treatment that results in a longer, healthier lifespan.”

Nunnally said that, ideally, every American would be tested at least once, but noted that it would still be possible for the patient to decline the test.

In its recommendations, the CDC will suggest that repeat HIV testing would only be for high-risk individuals such as intravenous drug users, men who have sex with men or the sex partners of HIV-positive people. But it will also recommend repeat testing for those whose sex partner has had a new, or more than one, sex partner in the past three months.

Finally, the CDC wants to do away with what it believes is a barrier to HIV testing: the required 45-minute pre-test counseling session used in most states, including Texas, when a person requests an HIV test.

“Counseling services should be focused on those who test positive,” said Nunnally. “The purpose of these changes are to eliminate the complexities around HIV testing and reduce the stigma that still surrounds testing and diagnoses.”

Thousands of HIV tests are done annually in laboratories around the state. At the University of Texas Medical Branch labs alone, 66,985 HIV antibody tests were performed in fiscal year 2005 — including 43,960 for prisoners under a contract with the Texas Department of Criminal Justice system.

Among 23,021 nonprisoners tested by the medical branch last year, 299 were positive — 1.3 percent, according to the university.

All women preparing to give birth at a medical branch hospital are tested. The CDC’s Nunnally said that routine testing of pregnant women has led to the country’s “remarkable success” in declining rates for mother-to-child HIV transmission. In the mid-1990s, some 2,000 HIV-infected children were born annually, but that number has declined to a little more than 300 a year in recent years.

“HIV testing is part of general care for pregnant women, without a separate, specific consent form,” she said. “We hope to extend that success to other adults.”

Last year, Galveston County Health District medical personnel saw 1,439 people at clinics in Galveston, Brazoria and Chambers counties being screened for HIV. The blood samples were sent to state labs in Austin for testing.

“We welcome any action that allows people to get a better understanding of their health. If someone is not aware of their status, then learning (about being HIV positive) is important for them and the community,” said health district spokesman Kurt Koopman, when asked to comment on the broad CDC testing proposal.

William O’Brien, a medical branch professor and physician who treats AIDS patients — also a leading research expert — agrees that the CDC’s proposed approach is a good one and that the lengthy pre-test counseling is a barrier to testing.

“The CDC is trying to tackle the problem of all these undetected HIV infections and make it easier for people to be tested. This is a good way to get the testing done,” he said.

Still, social workers dealing with AIDS patients, while agreeing with the CDC proposal, say existing social taboos about HIV/AIDS are a barrier to any testing.

“A lot of the female clients we see had a positive test only because of the testing done for pregnant women,” said Georgia Nelson, director of operations at the AIDS Coalition of Coastal Texas, which provides social services and other support to those living with HIV/AIDS.

“There is still that stigma, and people don’t want others to know they are infected, and more so with women than men. Like with alcoholism and substance abuse, women seem generally more ashamed to talk about (testing positive).”

A general lack of access to health care for many people, including the uninsured, also is a barrier to HIV testing, health care workers said.