HIV tests not yet as routine as cholesterol checks

By LAURAN NEERGAARD
WASHINGTON, 22 nov 2008 – Two years after the government urged making HIV tests as common as cholesterol checks, there are small gains but still one in five people infected with the AIDS virus doesn't know it, scientists said Thursday.

Eleven states that once required special consent for HIV testing have changed their laws, a key step to making an HIV test part of the standard battery that patients expect.

But HIV specialists meeting Thursday said other barriers include physician confusion about the ease of today's rapid tests, which can cost as little as $15 — although many patients seem to accept them.

No more than 100 of the nation's 5,000 emergency rooms routinely test for HIV in patients who aren't critically ill, said Dr. John Bartlett of Johns Hopkins University, who co-chaired the Forum for Collaborative HIV Research meeting. Yet because so many HIV patients are poor or uninsured, ERs are the health-care setting most likely to find them.

And while every pregnant woman is supposed to be tested so steps can be taken to protect her unborn baby, about 40 percent aren't, he added.

"Those are what we call missed opportunities," Bartlett said. Today, the test is "much better, it's much easier, it's much cheaper. The treatment is really great now."

Just over 1.1 million Americans are estimated to have HIV and 232,000 don't know it, according to the Centers for Disease Control and Prevention.

The CDC for years recommended routine testing mainly for people at high-risk, such as intravenous drug users. Then, finally, came drugs potent enough to keep HIV patients healthy for years, postponing the slide into full-blown AIDS. Yet nearly half of new infections still were being discovered too late for patients to benefit. Not to mention that people who don't know they're infected unwittingly spread the virus.

So in September 2006, the CDC recommended routine testing for everyone ages 13 to 64, whether they think they're at risk for HIV or not.

There is no nationwide data yet on the new guidelines' impact, CDC's Dr. Bernard Branson told The Associated Press.

But Branson listed encouraging signs:

_New York City's Health and Hospitals Corporation, the nation's largest municipal health system, has nearly tripled HIV testing — and late diagnoses dropped by about a third.

_New York's state Medicaid program has increased testing by 30 percent.

_Early results from a federal survey suggest 2.4 million more people in 2007 said they had ever been tested for HIV than said so in 2006.

_President George W. Bush in October signed a law allowing Veterans Administration clinics to ease testing requirements.

"I don't think anyone at CDC anticipated that we would test the whole country in a single year," Branson said.

But in pilot projects around the country, "people are taking the recommendations to heart and implementing them as much as was feasible for them," he added. Moreover, "we find people are very receptive to being tested, and there was concern about that before."

Indeed, studies presented Thursday suggest more than 80 percent of emergency-room patients were amenable to an HIV test while most ER workers opposed testing them. Why? Presumably because ERs are so busy and there's confusion about how much HIV counseling is needed.

But Bartlett demonstrated how to quickly give people a chance to either opt out or request counseling: "Mr. Jones, you're going to have a cholesterol test, a blood count, and an HIV test — and by the way we do the HIV test on everybody because that's what the CDC has recommended. Is there any part of this that you want more information about or you don't want to have?"

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On the Net:

State HIV testing laws: http://www.nccc.ucsf.edu/StateLaws/Index.html