CDC Shifts Focus To Increasing HIV Testing

Guests

Dr. Bernard Branson, associate director for laboratory diagnostics in HIV/AIDS prevention at the CDC
Donald G. McNeil Jr., science reporter, New York Times

More than 200,000 people in the U.S. are living with HIV and don't know it, according to the Centers for Disease Control and Prevention. On World AIDS Day, the CDC has announced a higher focus on getting people tested — especially those who are at higher risk.

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TONY COX, host:

This is TALK OF THE NATION. Im Tony Cox in Washington. Neal Conan is away.

Nearly a quarter million people in America have HIV and don't know it. Perhaps it's because 55 percent of adults in this country have never been screened for the infection. But testing has been on the rise the last four years, since the Centers for Disease Control and Prevention recommended that all adults be screened regularly.

Cities are reaching out to high-risk groups in different ways, as well, from hip-hop campaigns to free testing at the DMV. The CDC has now made HIV testing one of its top priorities.

Have you been screened, or encouraged a friend or loved one to get screened? And if you haven't, tell us: Why not? Our number here in Washington is 800-989-8255. Our email address is talk@npr.org. And you can join the conversation at our website. Just go to npr.org, and click on TALK OF THE NATION.

Later in the hour, it's been a long battle against HIV and AIDS. We want to know who you remember on this World AIDS Day or who you'd like to acknowledge. Tell us about them. You can send us an email now. That address again, talk@npr.org.

Right now we focus on HIV screening. Joining us is Dr. Bernard Branson. He is an associate director in HIV/AIDS with the CDC. He joins us from Georgia Public Broadcasting in Atlanta. Dr. Branson, nice to have you on the program.

Dr. BERNARD BRANSON (Associate Director for Laboratory Diagnostics in HIV/AIDS Prevention, Centers for Disease Control and Prevention): Thanks. Good afternoon.

COX: Why do so many people have the infection and not know it?

Dr. BRANSON: I think one problem that we've had is that people feel they need to be at risk. They have to have a special reason in order to get tested. And the CDC has been encouraging people to get tested as part of the routine as care, ask their doctor for an HIV test or go out to seek an HIV test in order to reduce the number of people who are unaware that they're unaffected.

About 200,000 of the nearly one million people in the U.S. who have HIV are not aware they have the infection.

COX: You are trying, you meaning the CDC, to improve the numbers of people who or to increase, I should say, the numbers of people who are being tested. How are you going about doing that?

Dr. BRANSON: There are a couple of approaches that we've used. Since 2006, CDC has recommended that physicians in hospitals, in their offices, in emergency departments, screen people for HIV when they come in, regardless of the reason that they're coming in.

CDC also supports a large number of community organizations who work with persons who need to be tested, people who may not be accessing the health care system. So there are numerous testing sites throughout the country, in a number of different states where people can go to get an HIV test without having to go to the doctor.

For someone who does want to get tested, there's a website, hivtests.org, where you just put in your zip code, and you can find an accessible testing site for free testing close to where you live.

COX: Is mandatory testing something that you support?

Dr. BRANSON: Mandatory testing has not been something the CDC has ever supported. We support the idea of routine testing. We find that most people are amenable to testing, and actually many people think they have already been tested if they've gone to the doctor and had their blood drawn. But we don't really see a role for attempting to do mandatory testing.

COX: Would that not have an impact were it to be in place, mandatory? Not that it could happen necessarily, but if it were, could it have an impact on these numbers?

Dr. BRANSON: I don't think that it would have much of an impact. When you talk about mandatory testing, there's no way really to implement it. I think that's certainly not something that we would encourage in the United States. But activities that we're currently taking in order to reach people, I don't really know how you expand them in order to implement something that would be mandatory.

COX: What reasons do people give for not getting tested?

Dr. BRANSON: Interestingly, when we look at people who are offered testing in health care settings, one of the most frequent reasons they give for not getting tested is that they've been tested before. But the second most common one is that they say they're not at risk, so they don't need an HIV test. And I think that is the biggest obstacle that we're trying to overcome.

COX: Do you find that there are certain groups of people who do get screened more often than others, and if so, who are they?

Dr. BRANSON: There are several groups of people who are screened more often than others, or at least who report that they've been tested more often than others.

There's been a huge initiative since 1995, for example, to screen all pregnant women while they are pregnant because if you provide therapy to infected women who are pregnant, you can really almost eliminate the chance that their baby will become infected.

As a result, testing rates among women in general are higher than they are among men. For example, the testing rates among women is around 50 percent say they've been tested, where it's only around 40 percent for men who say they've ever been tested.

In addition, the proportion of African-Americans who have been tested is around 62 percent compared to only about 40 percent among whites. And so there are certain efforts that really seem to have paid off in increasing testing among certain population groups.

COX: Let me bring in our second guest. It's Donald G. McNeil Jr. He is a science reporter for the New York Times. He covers HIV/AIDS and public health. He joins us from our bureau in New York. Donald, nice to have you on the program, as well.

Mr. DONALD McNEIL JR. (Science Reporter, New York Times): Thank you for inviting me.

COX: You've been covering this. What can you say in terms of what you have written about, seen, reported on with regard to the effectiveness of the efforts to increase the numbers of people being screened and tested for HIV?

Mr. McNEIL: Oh, it's a sad situation. It's not very effective. I mean, the CDC's line this year that a record of Americans being were tested for HIV in 2009, but the truth is that still leaves 55 percent of adults and 28 percent of people who are at high risk not getting tested. So we're not doing a very good job of reaching the people who need to be reached.

COX: And what alternatives to getting more people tested have you either reported on or do you suggest?

(Soundbite of laughter)

Mr. McNEIL: I'm a journalist. So I don't suggest. But, I mean, it can run the gamut. If you tackle this epidemic the way Cuba tackled the epidemic back in the 1980s. You know, Cuba is quite unique in that it has an HIV prevalence rate down there with Norway, Kazakhstan and Israel. It's one-sixth of the United States and one-twentieth of Haiti, which is right next door.

And they did it by in the 1980s, they simply looked for everybody who was potentially at risk, which included gays, but mostly people who have been to Africa. A lot of their soldiers have been to Africa over the years.

They tested all of them involuntarily, mandatorily. Everyone had to come in, sit down, name everybody he'd ever had sex with or she'd ever had sex with. All those people would be tested. They had to do the same thing, name their sexual contacts. And then everybody who was - tested positive was jailed.

It wasn't a cruel kind of jail. They were sort of like summer bungalow colonies. And the food was good, and the medical care was good, and you could live with whoever you wanted, and you could live with your gay partner, which is not true in the society outside.

But that's why Cuba has a now, they've stopped that. Since the introduction of antiretrovirals, people are now allowed to live on the outside. But it was that early action in the beginning of the epidemic that really suppressed AIDS in the United in Cuba.

COX: We're going to take a call in just a second. But already, the doctor has indicated that that was something that was even on the table for the CDC.

Mr. McNEIL: Of course not.

COX: Doctor?

Dr. BRANSON: Well, I can't imagine that we would put people in jail for a health problem in the United States. And that was, as Mr. McNeil pointed out, a long time ago, before we had effective therapy. And I think that's really the crucial ingredient at the current time.

Since really, the mid-1990s, we've had therapy that can give people essentially a normal life expectancy if they're diagnosed early and started on medications. There are over 35 effective medications for HIV in the U.S. And so we really need to view it a lot more as a health problem than we have to do as sort of a punitive problem the way Cuba did. I dont think that's something that we would want to emulate.

COX: Let's take a call. This is John(ph) from Binghamton, New York. John, welcome to TALK OF THE NATION.

JOHN (Caller): Hi, guys.

COX: Hello.

JOHN: Listen, I haven't had an AIDS test in about 10 years. I led a bit promiscuous lifestyle in my younger days. And I had a couple of AIDS tests. But I've been in a monogamous relationship for about 10 years now, and I was just wondering, should I get tested? I haven't had a blood transfusion or anything.

COX: That's a good question. Thank you, John. What about that, Dr. Branson?

Dr. BRANSON: What CDC recommends basically you know, you mentioned you had a promiscuous lifestyle. Now you're in a stable relationship is that if you or if your sex partner has had more than one partner since your last HIV test, you should get a test again.

And that is really on the basis of what kind of risks you might have encountered so that if you've been tested since you entered this relationship, it's not necessary to be tested again, but if you have had a sex partner since your last HIV test, you need another one.

COX: Here's another doctor who's joining us. He's from Gainesville, Florida. This is John(ph). John, welcome to TALK OF THE NATION.

JOHN: Hi. I'm a physician right out of training here down in Gainesville, Florida. And I myself, personally, have been tested for HIV, just simply to be tested. I know I was never forced to be tested during any of my training.

I know a lot of my fellow trainees and fellow residents when I was going through training, had needle sticks, had scalpel cuts with patients. And they didn't know their HIV status, as well as the patients didn't know their HIV status.

And there is a lot of bureaucracy that goes on in trying to find out each other's HIV status and antiretroviral therapy and such, and I would like to know what the CDC's feeling about that is, about people who have inadvertent needle sticks and protecting our health care professionals.

COX: John, thank you very much for the call. Dr. Branson?

Dr. BRANSON: Thanks for the question. CDC's position, first of all, is that HIV testing ought to be as routine as a cholesterol test. You talked about having, you know, a lot of difficulties in either getting a test or getting test results.

Certainly we encourage that if there's been an occupational exposure, like a needle stick or a scalpel cut, that the person who was the source of that exposure, the patient, gets tested, that the provider, the physician or the nurse who suffered the needle stick, also get tested and if that patient tests positive that the physician or the nurse who received the needle stick get started on therapy because it's been shown to very effectively prevent infection.

I think the real issue, though, as you talked about people having these exposures in hospitals, is part of the reason that CDC says that people should be tested routinely, when they enter the hospital, when they're seeing their health care provider. So you don't wait until there's a needle stick in order to get an HIV test.

COX: We're going to be going to a break in a few moments, and I'm going to come back after that break, Donald McNeil, with a question for you. We know that different countries around the world have handled the HIV/AIDS epidemic differently, some more effectively than others.

In your reporting, I'd like to get you to talk about what you have seen around the United States and which cities, which regions of the country seem to have tackled this better than others.

Our other guest is Bernard Branson, associate director for laboratory diagnostics in HIV/AIDS prevention at the CDC. We're talking, of course, about HIV testing on this World AIDS Day. Have you been screened or encouraged a friend or loved one to get screened? And if you haven't, tell us why not. Our number here in Washington, 800-989-8255, the email address, talk@npr.org. I'm Tony Cox. It is TALK OF THE NATION from NPR News.

(Soundbite of music)

COX: This is TALK OF THE NATION from NPR News. Im Tony Cox. Neal Conan is away.

On World AIDS Day, we are talking about screening and why so many people have never been tested for HIV. Dr. Bernard Branson serves as associate director for laboratory diagnostics in HIV/AIDS prevention at the CDC. He wrote the latest CDC HIV testing recommendations. Also with us, Donald McNeil Jr., a science reporter for the New York Times.

Have you been screened or encouraged a friend or loved one to get screened? And if you haven't, we'd like to know why not. Our number here in Washington, once again, 800-989-8255. The email address: talk@npr.org. And to join the conversation at our website, go to npr.org and click on TALK OF THE NATION.

Before we get to our next caller from Kalamazoo, Michigan, let me come back to you, Donald McNeil, and ask you whether or not you have noticed in your travels and coverage of this issue around the United States: Is there a city, is there a region, is there a place that is dealing with this more effectively than other places?

Mr. McNEIL: You know, I've been contemplating this during the break. I mostly cover AIDS internationally. So I know sort of better what's going on in other countries than I do in our country.

Vancouver, Canada, which is obviously not the United States, does quite a good job. They have both a large gay population and a large injected-drug-user population. And they really make an effort to reach out to those people.

And the radical thing they do in Vancouver is that they actually have a site where people can inject whatever drugs they buy on the street under the eyes of a nurse. And then they're encouraged to get an HIV test or have treatment for their abscesses or any number of other things.

That's something we'd have a hard time doing in the United States, but it might be possible. I know the DNA people have visited Vancouver to see how their program works.

But that is in Canada, and Canada has a much better working health care system than the United States does. The problem from one city to another almost makes no difference because we have such a lousy health care system in the United States. And it's particularly lousy for the groups of people who are at high risk for AIDS.

That is, we're pretty good at getting children to get their immunizations in this country, to get their diphtheria and measles and mumps and rubella shots because we tell them you can't come to kindergarten unless you've had their shots. But once kids are out of high school and getting into the age where they're sexually active, in high school or out of high school, they rarely see the doctor, and they're too old for their mothers to make them.

They rarely have a doctor. And kids in their teens and 20s and early 30s often don't go to a doctor unless they think they've got a disease, and it might be a sexually transmitted disease. They often don't have a doctor.

The disease hits hardest at poor people, who often don't have insurance. So they have little ability to see a doctor. And, you know, getting tested for AIDS is normally something that happens either when you get sick, when you have your first seizure or your first bout of pneumonia or something like that, when you've actually got the beginnings of AIDS, or when you have routine health care.

And most teenagers and young adults in this country don't have or don't take advantage of routine health care. So it's a real gap in the system, and it's unfortunately, that's where AIDS is at its strongest.

COX: Let's take another call. This is Joanna(ph) from Kalamazoo, Michigan. Joanna, welcome to TALK OF THE NATION.

JOANNA (Caller): Afternoon, gentlemen.

COX: Good afternoon.

JOANNA: The main reason I'm calling, and understand, I say this knowing that culturally and socially, I certainly feel like I'm in the minority, I have not actually been tested, at least not sought out testing. And it's because, you know, there are those of us still who haven't had sexual partners, haven't had any drug use, no surgery, no blood transfusion.

And one of the questions I did have for Dr. Branson is: As small as that population may be, how is that reflected in that 55 percent? Because there are still those of us out there who, while we do encourage and support testing for anybody who'd be even remotely at risk, I rarely feel like, you know, I'm represented in the numbers or in that dialogue.

COX: Joanna, thank you for that question. What about the answer, Dr. Branson?

Dr. BRANSON: Yeah, I do appreciate that question because as people sort of focus on the 55 percent who haven't been tested, we do acknowledge at CDC that we're not trying to get every last person tested in the United States.

For example, our recommendation for health care providers is they should be testing their patients if the yield for testing is more than one per thousand or one infected person per thousand people get tested. Otherwise, you go back to focusing your testing on persons who are just at high risk.

I don't find the situation, I think, quite as grim as Mr. McNeil talks about. There are a couple of very, very good programs in the United States. For example, in New York, there's the Bronx Knows campaign, which has really had a dramatic effect by increasing their testing about 30 percent.

In Washington, D.C., there's the Get Tested D.C. There's Test Miami. Houston, in fact, in terms of reaching young people, has a series of concerts they call Hip-hop for HIV, where essentially the price of admission is to get an HIV test and you get a test, you know, you get a ticket for the concert. So I think there have been some very innovative things that have happened in order to get young people tested in the United States.

COX: Donald, your comments about Vancouver generated a phone call from Vancouver. But before we take that, Dr. Branson, you mention Washington, D.C., as a place that has some innovative testing and yet, Washington, D.C., remains, as I understand it, one of the worst in terms of the incidence of HIV in America. Why hasn't the testing been even more effective in a place where it appears that it is needed most?

Dr. BRANSON: Well, testing doesn't eliminate HIV infection. Testing identifies people who have HIV and the people who need care, and that's what's been happening in Washington. This initiative that they have undertaken is one of the reasons they've been able to find out that the problem is as severe as it is in Washington, D.C. And they've mustered the resources together with collaborations, for example with the NIH, in order to move forward on specific campaigns to, number one, make sure people get the care they need; and number two, that they take the steps that are necessary in order to prevent the infection from spreading.

COX: All right, let's go to Vancouver, Washington. Actually, it was Vancouver, Washington, not Vancouver, Canada. Jeremy(ph), welcome to TALK OF THE NATION.

JEREMY (Caller): Thank you. I just had a quick question on whether or not I should be tested. Over a month ago, a friend of mine who has AIDS fired my rifle. The scope hit him in the head and cut him and got some blood on it. And then the same thing happened to me a couple days ago. I figured I don't have to be tested, but I thought I should ask.

COX: Thank you for the call. What about it, Dr. Branson?

Dr. BRANSON: Well, I don't think you need to be tested because of the rifle that you're talking about. I think that if there are other circumstances, you know, that might put you at risk, it's worth getting an HIV test.

Many people feel that, you know, we ought to be testing for HIV like we used to test for syphilis. As Dr. Bartlett(ph) at Johns Hopkins said, every time you turned around, you used to get tested for syphilis, when you went to the hospital, when you got married.

And so I don't want to say no, you don't need to get tested, but I don't think that the rifle injury you're talking about is a reason for an HIV test.

COX: What about donated blood? Is that an issue and to what extent is it?

Dr. BRANSON: All blood donors have been tested for HIV since 1985, when the antibody test first came out. And in about 1990, when the test for the virus itself, for RNA, became available, all units of blood were screened for the virus, as well as for the antibody in order to eliminate any infections that might happen before antibodies develop.

And so the blood supply is really quite safe. It's extremely rare. There have really been only four cases of infected units of blood identified since 2000 in the United States, and that's out of about 12 million blood donations every year, so that there's very little concern about the blood supply.

COX: Here's a tweet from Keemie(ph), I believe is the name: I have been tested. My state mandates testing of pregnant women, twice during pregnancy. Easier to test than to opt out. What about that, Don? That is one example, if this is correct, where there are certain circumstances under which testing for HIV/AIDS is apparently mandatory. Is that correct?

Mr. McNEIL: Sorry, are you asking me?

COX: Yes, Don, I'm asking you.

Mr. McNEIL: Yeah, actually, I'm glad that Dr. Branson brought up syphilis because I remember when I was married in 1980, I was married in Connecticut, and I had to take a syphilis test. And I thought, well, this is bizarre. Here's a disease that's been pretty much curable for the last 40 years, and I have to take a test for it, and yet it was mandatory in order to get a marriage license.

Now we have a disease that is also a fatal sexually transmitted disease, and we have to do things like bribe kids with concert tickets in order to see whether or not they've got a fatal, transmissible disease. It's a sort of odd shift that's taken place in the country in the last 50 years, where some kinds of health care are mandatory. Most places, you can't get into kindergarten without having had all your shots. But we have voluntary testing in the DMV, but you could change the law so that you couldn't get a driver's license without taking an HIV test. You could change the law so that you don't have a couldn't get a marriage license without taking an HIV test, you couldn't renew your driver's license.

There are all sorts of ways you can it's an interesting modern notion that the health care system has become quite as voluntary as it has because not that long ago, in New York City, when Dr. Tom Frieden, who's now the head of the CDC, was the health commissioner in NYC, people who had multi-drug-resistant tuberculosis and refused to take their medications were not allowed to wander around while they were still in the infectious stage. They could actually be, you know, the equivalent of chained to a hospital bed until they weren't infectious anymore.

So there are times - and the laws exist on the books. It's a question of whether or not you want to apply them.

COX: All right, let's take another call. This is Holly(ph) from Fenton, Michigan. Holly, welcome to TALK OF THE NATION.

HOLLY (Caller): Hi.

COX: Hi.

HOLLY: I was just calling to share my experience when I went in to go get an HIV test after a divorce. I was kind of worried, you know, about what my partner had been doing. And I didn't go to my general physician. I went to Planned Parenthood because I was a little, I don't know, I guess trying to keep it secretive, as you would say.

And I was argued with by Planned Parenthood: Oh, you should not take this test. And they tried arguing with me, telling me that if I take it, you know, and I find out, then I'm going to have a whole world of trouble. And I said, well, yeah I would have a whole world of trouble, but I'd rather know. And they - and I've never heard of anything like that happening before. Does that happen often?

COX: Holly, thank you for that. Is that in issue within the medical community, Dr. Branson, where there are those who are actually against having HIV tests like this?

Dr. BRANSON: I think that the - fortunately, that situation is rare compared to what it had been in the past. In other words, prior to 1995 or so when effective therapy was available, there was a lot of downside to an HIV test in terms of discrimination or stigma, and there wasn't much you could do about it. And so at that, you know, particular point in time, I think that there were people who were perhaps more negative.

The attitude that your caller just described is one that we really are trying to work on at CDC and we're trying to connect - trying to correct, because the idea that you're going to be in for a whole world of trouble, where, in fact, what you will have is access to therapy that would give you a normal life expectancy, that will reduce the possibility of infection, for me(ph), is a very powerful reason to get tested. And so I think it's an uncommon situation at this point where health care providers would discourage someone from getting tested.

COX: Let me share a couple of more emails that we have gotten in. This one is from Annette in Minneapolis. She writes: My husband, a general surgeon, is tested for HIV and hepatitis C every year through work because he is exposed to blood every day. In medical school, he was working with a man dying of AIDS when my husband accidentally stuck himself with a needle. Luckily, he never acquired HIV, but my heart goes out to anyone fighting this horrible disease. The wait for those test results is an eternity.

How long does it take to get the results back, Dr. Branson? Do you know?

Dr. BRANSON: It really depends. I mean, right now, there's a variety of different tests. And in particular, there are rapid HIV tests that are being used in a large number of places where you can get a result in less than 20 minutes from, you know, either a swab inside the gums or from a finger-stick blood sample.

But conventional HIV tests, when they're sent off to the laboratory, it's really the transportation and the processing that take the longest time because the results themselves can be back in anywhere from one to four hours. So the older process where things were sent off to a special, centralized laboratory and it took a week or it took two weeks to get the test results back, that again is very uncommon these days.

COX: Here's another one. This is from Micah, in San Francisco. I work at a needle exchange in San Francisco that offers free HIV testing, but only to those that are deemed to be at high risk after a screening process, namely injection drug users, MS men - men who have sex with men - and transgender individuals. This disqualifies heterosexual men and women more often than not, even after those individuals have disclosed unsafe sex practices. Many of the people we are forced to turn away are of ethnic and/or socioeconomic minorities with little-to-no access to health care or health education counseling for risk reduction. How would address this disparity in free testing and using risk groups to screen those who want free HIV tests? I'm going to direct that question to you, Donald McNeil, in just a second.

We are continuing our focus, of course, on World AIDS Day. So many family members and friends and colleagues have been lost to this disease. We'd like to hear from you. Give us a call: 800-989-8255. Our email address is talk@npr.org.

You're listening to TALK OF THE NATION, from NPR News.

So, Donald, have you experienced that kind of situation in your coverage of HIV/AIDS around the country, even though I know a lot of what you have done is international?

Mr. McNEIL: Well, what you're describing - it sounds like the person is describing a policy that their needle exchange program came up with probably because they don't have enough money to test everybody who comes in. I mean, good medical practice would suggest that they would test everyone who comes, especially people who come in saying I've engaged in high-risk sexual practices, even though I'm heterosexual. It may be that they just set this policy because they don't have enough money to buy the tests and to give everybody counseling.

It's too bad, because, as the CDC says, you know, you'd like to test not only people who engage in high-risk sex but people who've ever had any old sex and people who've, you know - it should be as routine as cholesterol. You don't have to live entirely on steak and eggs in order to qualify for a cholesterol test. So you shouldn't have to come in and disclose your entire sexual history in order to ask for an AIDS test.

COX: We have not talked much about the more mature population with regard to testing. And I'd like to go to Roger from Casper, Wyoming.

Roger, welcome to TALK OF THE NATION.

ROGER (Caller): Hi. How are you guys today?

COX: We're fine, sir.

ROGER: My question was - I'm 58 years old, been in a monogamous relationship with the same woman my entire adult life. Don't engage in anything risky, no drugs or anything like that. I never had an AIDS test because I didn't think it would be necessary. And I was listening to this program today, and I thought I should call in ask if I should be tested, if my wife should be tested. Are there other ways other than risky sex or drug use that this could come about?

COX: All right. Thank you for the call. What about it, Dr. Branson?

Dr. BRANSON: As I mentioned, CDC is recommending everybody between the age of 13 and 64, when they see their health care provider, consider getting an HIV test. I mean, there's not really a downside to getting a test. I mean, the worse that can happen is you have a test that's a negative. And similar to having a normal PSA or a normal cholesterol, it just basically can reassure you. So I don't think that there's a reason to saying no, don't get a test.

Obviously, the situation that we just heard, there's not a lot of high risk. But I think also, as Don McNeil pointed out, you don't have to live on steak and eggs in order to get a cholesterol test. You don't have to basically earn the right to an HIV test, either.

COX: David, I have about 15 seconds for your question. This is David from Overland Park, Kansas.

DAVID (Caller): Yes, sir. I was just going to let you know I get tested every time I change partners, and I actually carry my test results in my wallet.

CONAN: Thank you for that. Is that something that you have found, Dr. Branson - as we bring this to a close, quickly - that people who do get tested are vigilant about it?

Dr. BRANSON: I think we're finding that increasingly - and that's something that CDC recommends. People who are changing partners, people who are having multiple contacts need to get tested more often, not just once. And so I think this vigilance is something we'd encouraged.

COX: Our guests have been Dr. Bernard Branson, associate director of laboratory diagnostics in HIV/AIDS prevention at the CDC, and Donald G. McNeil, Jr., science reporter for the New York Times. Gentlemen, thank you both.

Dr. BRANSON: Thank you very much.

Mr. McNEIL: Thank you.

COX: We will continue our focus on World AIDS Day in just a moment. So many family members and friends and colleagues have been lost to this disease. So many others fought to make their lives a little better. Tell us: Who do you want to remember? Who do you want acknowledge on this day? Tell us about them. 800-989-8255. The email address: talk@npr.org.

I'm Tony Cox. It is TALK OF THE NATION, from NPR News.

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