AIDS screening makes sense
AIDS screening makes sense
Published on: 09/25/06
Nearly three decades into the AIDS epidemic, public health officials are finally recommending that all teenagers and most adults be tested, at least once, for HIV.
The proposal, announced by the Centers for Disease Control and Prevention last week, represents a seismic shift from the early days of the deadly epidemic, when public policy yielded to objections from activists that those who tested positive would be socially ostracized if AIDS testing became a routine part of medical screenings.
Those fears were not always unfounded. The disease, which at the time claimed lives quickly, struck homosexual men hardest. And people with AIDS often found themselves fighting for insurance coverage and against discrimination in the workplace and elsewhere.
But with new treatments that prolong life and better anti-discrimination laws, those fears have settled considerably over the last 15 years. Moreover, the face of the epidemic has also changed. Many of the newest infections are among members of ethnic minority groups, teenagers and women who acquire it through heterosexual transmission. Routine screening for the virus makes much more sense.
Fifty to 70 percent of all new cases in the United States are now being diagnosed in people who were unaware of their AIDS status, the CDC says. The agency's research has shown that once people are aware that they are infected, they take steps to protect themselves and their sexual partners.
The new recommendations call for physicians to offer HIV testing of all teenagers and adults up to age 64 as a routine part of any health screenings, like those now offered for cholesterol and blood sugar levels.
They also call for all pregnant women to be tested at least once, and those who report having multiple sex partners or who inject drugs should be tested twice — at least once late in their pregnancy to prevent passing the virus on to their babies. (Since AIDS testing has become more routine for pregnant women, the number of babies born with the virus has dropped from 1,650 in 1991 to fewer than 250 last year.)
Patients would be offered the option of declining the test, and as a practical matter most of those adult patients in long-term monogamous relationships may not want it, experts believe. Still, physicians should raise the issue for them to consider, the CDC says.
Most of the recommendations can be implemented in routine physician interaction with patients, but some may require a change in state laws. For instance, the CDC recommends that states no longer require separate, signed consent forms or that the patient go through lengthy counseling before testing.
Since the start of the epidemic, 500,000 Americans have died from the disease, and more than 1 million have been infected. As many as 250,000 people do not know they are infected.
If AIDS testing becomes a routine part of a medical screening for these patients, the nation will get closer to three goals — no more HIV-infected children, no one with it going for years without treatment and eventually no more new cases of the disease.
— Mike King, for the editorial board
source: Atlanta Journal-Constitution editorial Sep 25, 4:00 PM
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