By Steve Sternberg, USA TODAY
AIDS virus testing should be offered regularly to everyone ages 13 to 64 in every hospital, doctor's office and clinic to speed diagnosis and help curb the epidemic, federal health officials recommended Thursday.
The Centers for Disease Control and Prevention's recommendations are not legally binding, but they are designed to make HIV testing as routine as tests for high blood pressure, cholesterol and diabetes. About 1 million people in the USA are HIV-positive, but 250,000 of them have not been diagnosed, according to the CDC.
"It will allow us to identify a lot of people who have HIV and don't know it," the CDC's Timothy Mastro says.
ON DEADLINE: More information from the CDC
The guidelines no longer require health workers to provide special counseling before and after the test, and they lift the requirement that patients supply specific written consent, though patients must be given the opportunity to refuse testing.
Daniel Kuritzkes of the University of Colorado, chair of the HIV Medicine Association, says, "I think the guidelines will help destigmatize HIV testing by making it part of routine medical care and not a test with some special mystique about it."
More than a dozen AIDS advocacy groups released a statement objecting to the decision to drop counseling.
"We fear that some health care settings will interpret today's announcement as a call for universal screening and test patients without informing them or arming them with the information they need to avoid putting others at risk," says David Munar of the National Association of People with AIDS.
Peter Staley, a founder of the protest group ACT UP, disagrees with his peers: "The bottom line is that we're really losing the fight here. We're losing lives. I'm an ACT UP grad, and our motto is 'by any means necessary.'
"I realize that abandoning written informed consent raises issues. People are worried about privacy and stigma. But the bottom line is that this would probably save lives, and that's why I'm very much in favor of it."
Even patients diagnosed late in the course of the disease can extend their life expectancy by 14 years with standard treatment, according to a recent study led by Rochelle Walensky of Harvard Medical School.
Patients diagnosed soon after infection can extend their lives by as much as 25 years, she says.
Mastro says diagnosis is a powerful tool for prevention. "We think that the quarter of a million people who don't know their infection status account for 70% of sexually transmitted infections," he says. "We have very strong data showing that when patients know they're infected, they take strong measures to avoid infecting others."
Studies have shown that AIDS testing is as cost-effective as tests for high blood pressure and colon cancer.
The new guidelines leave open two key concerns: who will pay for the tests and the cost of treating 250,000 new HIV patients.
"The strain that this is going to place on Medicaid, the Ryan White Care Act and the state AIDS drug assistance programs is going to be enormous," says A. David Paltiel of Yale University, who has studied the test's cost-effectiveness.