The Call for Routine HIV Testing Grows in the U.S.

To stop the spread of HIV among populations where the infection is on the rise, federal health experts are proposing HIV testing as a routine part of medical care. The hope is that people who know they are infected would seek care and would not infect others. But there is a risk that without proper counseling and resources, people who test positive may be afraid to come forward for treatment.

MELISSA BLOCK, host:

This fall the federal government is expected to call for routine HIV testing. That would mean doctors and hospitals will offer tests whenever people come in. Many doctors say that would help prevent the spread of the disease.

The call for routine testing is growing in the U.S., as NPR's Brenda Wilson reports. That's because experts say prevention programs alone are not reducing new cases of HIV.

BRENDA WILSON reporting:

The District of Columbia has a rate of HIV higher than the national average. It's estimated that 1 in 50 in the city is infected with the virus. So the city health department got out in front of the federal government a month and half ago and launched a campaign of the universal HIV test.

Dr. Veronica Jenkins at the Family Medical and Counseling Center, a small neighborhood clinic, says since testing started 10 people have been diagnosed with HIV.

Dr. VERONICA JENKINS (Family Medical and Counseling Center): Ten is small, but not if it has the ripple affect. How long have they been positive? Suppose it has been a year? Or five years? Think about the partners each of those 10 has had, or the partners of the partners. Now we're talking about a lot of people not just 10.

WILSON: Because of the public reaction to AIDS in the early days and people's fears, Dr. Jenkins says people have to be counseled even before they are tested.

Dr. JENKINS: What happens if you need to talk about this with your family? Who do you discuss this with? When is the appropriate time to discuss it? How do you deal with the fact that you have a disease that was at one time thought of as a terminal illness?

It takes a lot of discussion to kind of acclimate this to yourself and your lifestyle and to your family members and friends.

WILSON: But the Center for Disease Control and Prevention doesn't think it's necessary. It's about to recommend that health care providers don't have to council or obtain written consent before testing.

New York City's health commissioner, Dr. Thomas Freeden, agrees.

Dr. THOMAS FREEDEN (New York City Health Commissioner): The biggest barrier to people not getting HIV test is doctors not asking if they want one. And a huge barrier to making it a routine part of medical care is the fact that it currently according to state law requires a separate written consent.

WILSON: Freeden has asked New York's legislature to eliminate requirements for pretest counseling and written consent. Oral consent would still be required. He also asks lawmakers to require that all people who test positive for HIV be connected to doctors and counselors.

Dr. FREEDEN: Once that test came back positive, we would actually enhance the procedure so that we would try to ensure that we do everything possible to encourage that person to get into care.

WILSON: But no one knows exactly how that would be accomplished. Dr. Paul Skolnick, the Director of the Center for HIV/AIDS Care and Research at the Boston University Medical Cente, says linking people to care is not as easy as it sounds.

Dr. PAUL SKOLNICK (Boston University Medical Center): We've had to literally walk patients into care so they don't get lost, if you will. Often patients find out a result and then get scared and don't show up in return visits. If you're testing and certain venues, like emergency departments, or you're having patients tested by providers who don't have any special expertise or system necessarily set up to link these patients to care.

WILSON: It's absolutely crucial he says to work out the kinks in such a system before you start it.

Dr. SKOLNICK: People will be getting positive results without the appropriate supports, will be spending lots of money to do this testing, to no good end since the patients will not be in care and getting the kinds of treatments they need. Or necessarily getting the prevention messages that they need to protect others who are not infected.

WILSON: Instead of testing everyone, it may be more cost effective to stick with testing programs that target high risks patients and know how to deliver them into to care as soon as the test results are in. But New York City Health Commissioner Thomas Freeden defends universal testing. He is part of a movement to begin treating AIDS like an ordinary medical condition.

Dr. FREEDEN: Everything that segregates HIV testing, that makes it different from the rest of medical care, not only increases a barrier and results in the spread of HIV but also, I think, increases stigma. Because the provider then makes a decision. This person looks like they might be HIV positive, that person doesn't. So I tell this person to go down the hall and talk to the HIV counselor. That's not a way to get a disease mainstream.

WILSON: The CDC says that one of the reasons people aren't routinely tested for HIV is that the test is not usually reimbursed. But the CDC doesn't recommend a way to pay for the test if they are routinely done.

Brenda Wilson NPR News.

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