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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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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.

Paltiel stresses that just because routine HIV testing is cost-effective doesn't mean it is free.

"It is expensive to test and counsel and treat people for HIV disease," Paltiel says. "It is efficient. But you do not get health for free. It costs to implant defibrillators for heart patients, or to screen for diabetes. And it's the same for HIV. It triggers a whole path of expensive drugs."

The U.S. has a program for ensuring that people with HIV infection have access to the drugs they need. But funding for that program already is stretched to the breaking point. Testing would add to those costs - because it doesn't do any good to find people with HIV if you aren't going to treat them.

"My feeling is momentum for widespread, routine HIV testing is going to build," Bozzette says. "People will begin to recognize that finding AIDS cases is not as cost-efficient as finding recent HIV infections. And by preventing HIV transmission, we have a chance in this country to draw a circle around the AIDS epidemic. We can reduce the probability that future generations will suffer the way this generation has."

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