Making HIV Checks Routine

The Centers for Disease Control and Prevention has launched a new initiative, "HIV Screening, Standard Care" to help physicians make HIV testing a standard part of the medical care they provide to their patients. The effort is designed to increase implementation of the CDC's 2006 HIV screening recommendations, which advise that all patients between the ages of 13 and 64 be tested for HIV as a routine part of medical care at least once in their lives -- regardless of perceived risk for the disease -- and that individuals at high risk (e.g., those with multiple or HIV-infected partners) be tested at least annually. "HIV Screening, Standard Care" is the latest phase of the CDC's Act Against AIDS campaign, launched in 2009 to refocus national attention on the U.S. HIV epidemic. "Many HIV-positive individuals walk out of their doctors' offices every day without knowing they have HIV," said Jonathan Mermin, MD, MPH, director of the CDC's Division of HIV/AIDS Prevention. "We know that physicians must provide an enormous amount of care during brief patient visits, so we developed 'HIV Screening, Standard Care' to make it as easy as possible for doctors to routinely provide HIV testing to patients." Key to Ending the U.S. Epidemic The CDC estimates that more than 200,000 individuals (one in five Americans living with HIV) are unaware of their infection, and these individuals account for more than half of all new sexually transmitted HIV infections. Numerous studies show that once individuals learn that they are HIV-positive, they take steps to prevent HIV transmission to their partners. Actions taken by HIV-positive individuals who are aware of their status highlight the importance of testing and diagnosing everyone who has HIV. Early diagnosis is also essential to help HIV-infected individuals live healthier, longer lives by linking them to care and appropriate treatment. Yet many individuals do not get tested until they are at advanced stages of the disease, when antiretroviral treatments are less effective and risk of death is higher. Recent CDC data show that 32% of those diagnosed with HIV progress to AIDS within one year of their diagnosis. The data suggest that these individuals were infected for about a decade prior to being diagnosed. This represents years of missed opportunities to help these infected individuals extend their lives though effective treatment, and prevent transmission to others. Lifesaving Opportunities Primary care physicians play a critical role in ensuring that Americans know their HIV status. CDC data show 72% of Americans report seeing a doctor in the previous year for a routine check-up. While the CDC's HIV screening recommendations are designed to increase HIV screening rates in busy medical settings by simplifying testing procedures, a 2009 survey of primary care physicians found that only 17% routinely screen their patients. The CDC cites significant demands on physicians' scarce time and resources, some state laws that currently do not permit routine screening, and the need for ongoing physician education as factors affecting the adoption of the recommendations. "It is critical that we adopt routine HIV testing for our patients," said Amir Qaseem, MD, Ph.D., a senior medical associate with the American College of Physicians and a member of the initiative's clinical work group. "As physicians, we play a crucial role in identifying those who are HIV-infected, providing timely treatment and care to extend their lives and helping them prevent transmission." "HIV Screening, Standard Care" is the newest phase of Act Against AIDS -- the CDC's five-year, $45 million campaign to reengage every American in the fight against HIV by combating complacency, increasing testing, and raising awareness among communities at risk. In addition to this initiative, several initiatives are focused on increasing HIV testing among populations at greatest risk, such as "Take Charge, Take the Test" for African-American women and an online advertising effort for African-American gay and bisexual men.