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This HIV Testing Day, June 27, 2006, the HIV Medicine Association (HIVMA) urges all sexually active adults to get tested at any of the thousands of testing sites set up around the country. But at the same time, HIVMA notes that every day countless opportunities are missed to identify more of the hundreds of thousands of people with HIV who don't know they are infected.
That's because today, HIV testing is not a routine part of medical care. In order to be tested for HIV, a person has to go through a process unlike that for any other medical condition: he or she usually must ask to be tested, give written consent, and go through counseling sessions before and after the test.
"That's a major barrier," said HIVMA chair Daniel R. Kuritzkes, MD, associate professor of medicine at HarvardUniversity and director of AIDS research at Brigham and Women's Hospital. "Even after years of contacts with the health care system, far too many people will not discover they are HIV positive until they are already showing clinical signs of AIDS. We would identify people with HIV a lot sooner -- and connect them with the care they need to extend their lives -- if HIV testing was a routine part of health care."
HIVMA is calling on the Centers for Disease Control and Prevention (CDC) to release its new guidelines to streamline the testing process in clinical settings, making universal, routine HIV testing a standard part of regular check-ups; doctors' office visits; hospital, community clinic, and emergency room care; and other healthcare settings.
Routine HIV testing has already proved successful for pregnant women, said HIVMA vice chair Arlene Bardeguez, MD, MPH, director of HIV services at the New JerseyMedicalSchool. "When a woman comes in for prenatal care, it's part of the package. We often identify women who are HIV positive whom we wouldn't have found otherwise, and we can get them care sooner than if they went undiagnosed. This approach has reduced mother-to-child HIV transmission from 25 percent in the 1990s to 1-2 percent currently."
"It's critical to catch the disease early," said HIVMA board member Michael S. Saag, MD, director of the 1917 AIDS Outpatient Clinic and director of the Center for AIDS Research at the University of Alabama at Birmingham. "The more damage the virus does to their immune systems, the worse patients respond to treatment, and the more likely they are to die sooner than if they get treatment early."
"Furthermore," Kuritzkes said, "HIV testing is one of the best prevention tools we have. Research shows that most of those who know their status change their behavior to limit their risk of transmitting the virus to others."
HIVMA says it believes testing for HIV should be handled the same way nearly every other medical test is. "When women have their annual OB/GYN exams, for instance," Bardeguez says, "the physicians don't have to do counseling and consent to test for syphilis and gonorrhea or to do their Pap smears. It's standard-of-care. The patients expect us to provide them with diagnosis and treatment as needed. What you don't know can hurt you.Â That is why we hope HIV testing will become standard-of-care, too."
However, identifying more people with HIV is only half the battle. "We need routine testing to make a serious dent in the number of people who don't know they are HIV positive," Kuritzkes said. "At the same time, once we have identified them, the resources to provide them with care also must be available. As HIV/AIDS is increasingly a disease of poverty, public programs need to be funded realistically to handle the growing caseload."
The government's largest program for low-income, uninsured, or uninsured people with HIV, the Ryan White CARE Act, is already under-funded and struggling under its current caseload. It will need a substantial infusion to support the newly identified patients who will rely on it for lifesaving care. HIVMA calls on Congress and the Bush Administration to provide leadership in the battle against HIV/AIDS in the United States.