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    Routine HIV Testing Advised for U.S. Adults

    Routine HIV Testing and Treatment: A 1-2 Punch That Could Put AIDS on the Ropes

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    Bozzette's calculation is that routine HIV testing and treatment can greatly slow the spread of AIDS. The effect can be great enough for a single medical advance - say, a vaccine that is only 50% effective - to wipe out AIDS in America.

    "For any epidemic to perpetuate itself, each infected person has to infect at least one other. The closer you are to driving that number below 1, the closer you are to extinguishing the epidemic," Bozzette tells WebMD. "So if you can identify people who are transmitting HIV and reduce the probability they are going to transmit, it makes it easier to move to that point. Then let's say we get a partially effective HIV vaccine that cuts transmission by half. Well, if you have already reduced transmission substantially, that may be enough."

    Can routine HIV testing really work? The idea is to link testing to routine health care. Anyone seeing a doctor, whether for a checkup or for emergency care, would be offered an HIV test. One-time screening would be enough for populations with very low HIV infection rates. For everyone else, testing every three to five years would be needed.

    Note that people would be offered an HIV test. It would be routine, but voluntary. Is there any reason to believe that enough people would agree to be tested?

    Yes, says Harvard researcher Rochelle P. Walensky, MD, MPH, co-leader with Paltiel of one of the studies. Working with the Massachusetts Department of Health, Walensky has already set up routine HIV testing programs.

    "Early on the acceptance rate was not high," Walensky tells WebMD. "Acceptance was lower than for prenatal HIV testing programs. A mom is more likely to accept testing when her baby is involved. But what we found is that, over time, the acceptance rate increases. So if we had routine, voluntary HIV testing, at first it would be a bit of a culture shock, then it would become normal."

    Walensky notes that many people are surprised to find out that their doctor isn't already testing them for HIV - a dangerous misconception that routine, voluntary testing would fix.

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