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Examining Recommendations For HIV Testing As Part Of Routine Medical Care

Ruzanna Harutyunyan's picture

The Los Angeles Times on Monday examined new practice guidelines issued recently by the American College of Physicians recommending routine HIV testing for all patients beginning at age 13, regardless of whether they engage in high-risk behaviors. CDC in 2006 also released recommendations for HIV screening as part of routine medical care.

Bernard Branson of the HIV/AIDS prevention division at CDC, who helped develop the agency's current recommendations, said that although physicians in the past might have limited HIV screening suggestions to high-risk patient groups, this approach often failed to identify new HIV cases. By recommending routine HIV screening for all patients, physicians can avoid asking patients sensitive questions about sexual activity and high-risk behavior. In addition, universal HIV testing can benefit teenage patients, who may be reluctant to discuss their sexual activity if they are accompanied by parents, Branson said. He added that patients can benefit from early HIV diagnosis because early treatment is more effective and can delay progression to AIDS. In addition, HIV/AIDS researchers say that increased awareness can slow the spread of HIV, because people who are aware of their HIV-positive status might engage in fewer risky behaviors.

According to the Times, obstacles to universal HIV screening are "falling away" as some states are requiring health insurers to cover HIV testing costs and fewer states are requiring counseling and informed consent before conducting blood tests. However, some physicians still might hesitate to suggest HIV screening because it could "open up a discussion that the physician feels he or she doesn't want to get into or doesn't have time for or doesn't have training for," Thomas Coates, director of the global health program at the University of California-Los Angeles David Geffen School of Medicine, said. He added that recommending universal HIV screening also raises questions about counseling, referrals and partner notification if the patient tests HIV-positive.

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However, Coates said it is important to recommend HIV screening even without follow-up discussions because it indicates to patients that HIV tests are an important component of medical care. This can convey important health messages to teenagers, Coates said, adding that when a physician recommends HIV testing, "it's kind of a signal to the adolescent that this is something that he or she needs to think about." Christina Elston, managing editor at L.A. Parent magazine, said HIV screening is "a health issue. It isn't a sex issue," adding that sometimes "parents confuse that" (Adams, Los Angeles Times, 12/8).

Related Editorial, Opinion Piece

* Washington Post: "The fear and stigma surrounding HIV and AIDS make it difficult to persuade people to get tested," and therefore "far too many cases of HIV infection go undiagnosed and untreated," a Post editorial says. According to the editorial, some health care workers might "find it too time-consuming" to offer routine HIV screening, and some health "insurers are balking at paying for the tests." However, time and money "shouldn't be more valuable than trying to save lives," it adds. The editorial calls for increased "focus" and "financial and political oomph at the federal level" to implement universal HIV screening and recommends implementing HIV/AIDS researcher Robert Gallo's recent call to create a version of the President's Emergency Plan for AIDS Relief for U.S. cities. The editorial states that PEPFAR "has provided antiretroviral treatment for more than 1.7 million people around the world since 2003," concluding, "Imagine what PEPFAR could accomplish at home" (Washington Post, 12/7).

* Elliot Millenson, Washington Times: The "staggering" 600,000 HIV/AIDS-related deaths in the U.S. since the virus was first discovered are "in part a testament to a predictable failure of people to conform to the government's AIDS prevention ideals of chastity, monogamy and protection," Millenson, the founder and former CEO of the Johnson & Johnson subsidiary that developed the first home HIV test, writes in a Times opinion piece. Although most people living with HIV in the U.S. "act responsibly, taking steps to prevent infecting others," Millenson writes that the "reality is that others know they are infected but don't take steps to inform their partners." According to Millenson, "If we want to get serious about HIV prevention in America, testing needs to be made a priority." He adds that it is "time to stop lying to ourselves that our AIDS prevention approach is working" because the numbers of AIDS-related deaths in the country "confirm it's not." Millenson concludes, "Promoting sound AIDS prevention approaches, which include encouraging Americans to know their and their partner's HIV status, as well as understanding the limitations of condoms -- and human nature -- will lead to a stronger and healthier America" (Millenson, Washington Times, 12/5).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.