Routine HIV testing fails in US

While the U.S. AIDS epidemic simmers largely unnoticed by most Americans, a failure to widely implement routine HIV testing continues to fuel its spread, HIV researchers and experts said.

Almost 60,000 Americans were infected with HIV last year, and, nationwide, 50-to-70 percent of new sexually transmitted infections are spread by people who do not know they are infected.

Guidelines issued two years ago by the U.S. Centers for Disease Control and Prevention (CDC) recommend that all Americans ages 13-64 be routinely tested in all healthcare settings.

Now, data show that although such testing could save years of healthy life and limit the spread of HIV, they are largely not being implemented.

“With HIV, ignorance is not bliss. Those who are unaware of their infection cannot seek treatment, and are at least three times more likely to transmit the virus,” said Dr. Veronica Miller, director of the Forum for Collaborative HIV Research.

The Forum for Collaborative HIV Research convened a national summit on November 19-21, at which some 300 leading HIV researchers, health care providers, and policymakers shared new data on the advances and barriers to early, routine HIV testing, considered a key to slowing the US epidemic which now encompasses more than 1.1 million Americans living with HIV.

New Testing Data Show Missed Opportunity as HIV Spreads in U.S. New data show that prior to 2006, Emergency Rooms (ERs) tested patients for HIV at a rate of just 3.2 per 1,000 visits (or .32 percent). Of 2.8 million ER tests performed over 12 years, six percent were HIV positive ? much higher than the national average of 0.17 percent of AIDS cases in the general U.S. population. Since then, the situation has improved only minimally, with some 50 to 100 out of 5,000 ERs nationwide routinely testing for HIV, according to Dr. Richard Rothman at the Johns Hopkins University Department of Emergency Medicine.

It is not only ER patients, which include large numbers of uninsured, but also those with full medical coverage from private insurance companies who are not getting tested, according to several studies. One study found that only 4.9 percent of plan members with a serious illness suggestive of AIDS were tested for HIV. The results came from a review of insurance claims for eight health plans in 2006, with a total of 7.8 million insured individuals.

A related study found that just 36 percent of members seeking treatment for sexually transmitted diseases-a high-risk group-were tested. A third study found that although drug treatment can prevent mother-to-child transmission of HIV, up to 41 percent of pregnant women were not tested for HIV, with rates varying by insurance plan.

And, although the prevalence of HIV among prison inmates is more than two and a half times that of the general U.S. population, most state and federal correctional facilities do not routinely test for HIV, instead testing based on perceived risk.

Veterans also have extremely high HIV prevalence. Existing VA regulations require written informed consent and documented pre- and post-test counselling. A recent nationwide study of VA hospitals showed that under these regulations, fewer than 10 percent of inpatients and fewer than 5 percent of outpatients were tested during the year ending Sept. 30, 2006.

But VA’s testing regulations will soon change, according to Dr. Ronald Valdiserri, head of the Public Health Strategic Health Care Group at the Department of Veterans Affairs (VA). In October, President Bush signed a law that lays the basis for the VA to revise its regulations, thereby eliminating outdated HIV testing signature consent requirements, and the VA is working to revise its internal guidelines accordingly.

“The healthcare system is routinely missing critical opportunities to identify and treat HIV-infected individuals-in emergency rooms, doctors’ offices, veteran’s hospitals and prisons,” said conference co-chair Dr. Ken Mayer, Director of the Brown University AIDS Program. “As a result, many patients are not tested until late in the disease, even when there are clear indicators of infection.”

Source: Forum for Collaborative HIV Research, USA

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