The Centers for Disease Control and Prevention recently recommended regular, routine testing for the AIDS virus for all Americans ages 13 to 64, which would make HIV testing as common as a cholesterol test.
These historic guidelines (endorsed by the American Medical Association) are aimed at stopping the spread of the disease and helping the 250,000 Americans who do not know they have HIV get the medical care they need. Nearly 50% of the HIV infections diagnosed every day are people who are already experiencing HIV-related illnesses and will have been transmitting the disease to other people. If people with HIV are diagnosed early, they will have access to life-extending therapy and can learn how to not transmit the virus to their sexual and needle-sharing partners.
Until recently, the Centers for Disease Control and Prevention recommended annual HIV counseling, testing, and referral (CTR) for people at high risk for HIV, including injection drug users (and their sexual partners), people who exchange sex for money or drugs, and men who have sex with men (MSM). The new recommendations however, are to test all pregnant women and to increase HIV testing of everyone seen in a health-care setting unless the patient declines, without requiring a special consent or counseling.
Since the 1980s, the demographics of the HIV epidemic in the United States has changed; more and more of the people getting infected with HIV are under 20 years of age, female, and members of racial or ethnic populations who reside outside of metropolitan areas, and heterosexual men and women who are frequently unaware that they are at risk for HIV.
The new recommendations include routine testing of everyone between the ages of 13 and 64 as part of their regular health care, and everyone treated for TB or sexually transmitted diseases. This is a historic change and one that places a huge HIV education burden on the health care system and parents everywhere. People all need to understand how HIV is transmitted and who is at risk.
For the healthcare system, telling people that a test will be performed, recording the result in their medical record, and notifying people of results will require thought, systems, and privacy protection. For parents, we need to talk with our children about HIV and sexually transmitted infections before their physical examinations and be able to help 13 year olds understand we are asking them to be vaccinated for HPV and tested for HIV.
Some fine points of the recommendation include 1) patients can decline the test, and 2) no person should be tested without their knowledge. What seems to be missing is a requirement that all Americans be educated about HIV transmission risk and understand that a negative HIV test is only valid until they have any unprotected sexual contact with someone or share HIV-infected body fluids in some other way.