CDC recommends testing for most Americans

[Jody]

 MSNBC Home » Health » AIDS

AIDS testing recommended for most Americans
Government wants routine screening for all between ages 13 and 64
 The government hopes to stop the spread of the deadly HIV virus by screening as many people as possible with tests such as the OraQuick oral HIV test.
 
• CDC urges widespread HIV screening

Sept. 21: The Centers for Disease Control and Prevention recommends routine HIV tests for all Americans between the ages of 13 and 64. CNBC's Mike Huckman reports.

ATLANTA - All Americans between the ages of 13 and 64 should be routinely tested for HIV to help catch infections earlier and stop the spread of the deadly virus, federal health recommendations announced Thursday say.

The U.S. Centers for Disease Control and Prevention said HIV testing should become about as common as a cholesterol check. Nearly half of new HIV infections are discovered when doctors are trying to diagnose a sick patient who has come for care, CDC officials said.

“We know that many HIV infected people seek health care and they don’t get tested. And many people are not diagnosed until late in the course of their illness, when they’re already sick with HIV-related conditions,” said Dr. Timothy Mastro, acting director of the CDC’s division of HIV/AIDS prevention.

“By identifying people earlier through a screening program, we’ll allow them to access life-extending therapy, and also through prevention services, learn how to avoid transmitting HIV infection to others,” he said.

The announcement was hailed by some HIV patient advocates and health policy experts. They said the guidelines could help end the stigma of HIV testing and lead to needed care for an estimated 250,000 Americans who don’t yet know they have the disease.

“I think it’s an incredible advance. I think it’s courageous on the part of the CDC,” said A. David Paltiel, a health policy expert at the Yale University School of Medicine.

The recommendations aren’t legally binding, but they influence what doctors do and what health insurance programs cover.

Some physicians groups predict the recommendations will be challenging to implement, involving new expenditures of money and time for testing, counseling and revising consent procedures.

Some physicians also question whether there is enough evidence to expand testing beyond high-risk groups, said Dr. Larry Fields, the president of the American Academy of Family Physicians.

“Are doctors going to do it? Probably not,” Fields said.

But the recommendations were endorsed by the American Medical Association, which urged physicians to comply.

“This is important public health strategy to stop the spread of HIV,” Dr. Nancy Nielsen, a Buffalo, N.Y.-based physician who sits on the AMA’s governing board, said in a statement.

No consent form needed
Previously, the CDC recommended routine testing for those at high-risk for catching the virus, such as intravenous drug users and gay men, and for hospitals and certain other institutions serving areas where HIV is common. It also recommends testing for all pregnant women.

Under the new guidelines, patients would be tested for HIV as part of a standard battery of tests they receive when they go for urgent or emergency care, or even during a routine physical.

Patients wouldn’t get tested every year: Repeated, annual testing would only be recommended only for those at high-risk.

There would be no consent form specifically for the HIV test; it would be covered in a clinic or hospital’s standard care consent form. Patients would be allowed to decline the testing.

CDC officials have been working on revised recommendations for about three years, and sought input from more than 100 organizations, including doctors’ associations and HIV patient advocacy groups. The CDC presented planned revisions at a scientific conference in February.

Since then, the CDC has strengthened language on informed consent to make sure that no one is tested without their knowledge, and emphasized the need for doctors to provide information on HIV tests and the meaning of positive and negative results.

[randym431]

I've been for this for a looooong time. Its what you "don't" know that can kill you. My gripe is that way too many people never have a clue they are hiv+, until their cd4 is <200, VL is high AND they are in the ER with PCP, or something else, fighting for their life.

Just no need for this...


Its way past time they stop treating HIV as "that dark dirty secret".

[DanielMark]

Really I think all countries should make this standard practice.

Unfortunately, ignorance and deep-rooted denial will prevent that from happening.

My 2 nickels.

Daniel

[aztecan]

I wholeheartedly support this. I know there are those who would be opposed to across-the-board testing, often citing the fear of disclosure and stigma.

But, the simple fact is, HIV doesn't care who it infects. I am seeing people who never suspected they were at risk. They don't fall into the high-risk categories, therefore were never tested.

When I get to meet them, they are often in the hospital, with PCP, MAC, CMV retinitis, PML and, in one particularly challenging case, all of the above plus a very severe case of KS.

The prognosis for these folks is not good. It isn't because they can't access quality medical care. It is unfortunate, but often some of these people are so weakened and they are fighting so many different infections that recovery may not be possible.

Had there been routine testing, many of these people  might not have found themselves battling for their lives and, all to often, losing the battle.

Whether the doctors climb on board with this is certainly not a sure thing. Let's hope they do.

HUGS,

Mark

[franfrog]

I do have to say I support this.  If this was in play many people would not get to the point I was at in the hospital with PCP and not know.  The only thing I worry about with this is ....Will it really help?  People like my husband who does not have insurance and feel like doctors are just to expensive, will still never find out.  Luckily in my area we had the clinic whih had free testing for my husband.  Other then that, he refuses to go to the doctor.  He will deal with a cold and tries not to think to much about his high blood pressure when it is up.  I hate how he does this but it is true insurance is expensive.

[alisenjafi]

Does safe sex stop at 64? Though I think this is a good idea to expose the hypocracy of America.

[aztecan]

Good point. I can see starting it at 13, but why stop at 64.

I hate to break this to the CDC, but people still have sex after 64, and 74, and 84.

In fact, seniors are probably at higher risk because they no longer fear pregnancy and often forego protection.

HUGS,

Mark

[ACinKC]

About damn time!  This shoulda been done in the late 80's or early 90's!

[Ann]

Johnny, I was wondering about the age 64 cut off too. Didn't Mark (Aztecan) mention only the other day that he had a client who was 70-odd and tested positive? (or did I dream that?)

Regardless of the absurd age cut off, I also think this is a very good move. We have been recommending routine screening over in the Am I forum for quite some time now. I don't know how many people actually take that recommendation on board, but we can only give them information, we can't make them act on it.

Fran brings up an excellent point - many people cannot afford regular check ups and many people are doctor-shy, especially men (in my experience). Maybe means-tested free testing is the way forward on that score - although I can see some people still not wanting to test in case they test positive, believing they won't be able to afford the care they need.

And speaking of which, a certain Dr. Saag is worried about what an increase in testing is going to do to America's health care system. The following is an excerpt from Tim Horn's article  available here at AIDSmeds:

While recommendations to increase HIV testing are being heralded as a vital public health strategy, there are also concerns that the U.S. healthcare system is already overburdened and not readily prepared to deal with an increased number of people diagnosed with HIV in need of treatment and expert medical care. "The programs they rely on to provide them with care are already bursting at the seams," Dr. Saag said. "Providers are overworked and burning out. Funding is too short to hire more staff, even as the caseload keeps increasing all the time. We're on the brink of a crisis in HIV care in this country."

What I cannot fathom is why Dr. Saag doesn't realise that it is far more cost effective to catch hiv infection in its early stages so a patient can be monitored and interventions made before they start coming down with (costly) OIs. To bury one's head in the sand will not stop the crisis from happening - unless he's hoping that by waiting until late stage AIDS has developed before a diagnosis is made, that the system will be saved through the death of the infected patient. It totally boggles my mind. He moans about funding limitations with no mention of the flat-line funding that has been going on for years now. I wonder how many ARVs a bomb would pay for? How many missiles would would it take to fund free testing for all?

I'm sure you all get my drift, so I'll get off my soapbox before I fall and break my neck.

Ann

[bear60]

"Does safe sex stop at 64? Though I think this is a good idea to expose the hypocracy of America." quote ali
I had the same thought......senior sex is just as risky as sex when you are 15 or 35. Those retirement communities and nursing homes had just better wise up. And I can say this because I will be 63 next year. Watch out.

[Life]

I am all for this as well...  But I also wonder if this will help US  - those who are already infected or will it stretch the system to the breaking point??  A wake up call??

[Eldon]

About damn time!  This shoulda been done in the late 80's or early 90's!

Hi Jody, it is Eldon.

I support this as well. There are so many people; straight or gay, that are walking around right now that is positive and they don't even know it. Just as others have said it, they don't even have a realization come to them until they are in the hospital with PCP or some other infectious disease.

It is definitely a form of strategy to use in addition to the education and prevention campaigns that exist today.


Have the BEST Day!

[alive2]

"Does safe sex stop at 64? Though I think this is a good idea to expose the hypocracy of America." quote ali
I had the same thought......senior sex is just as risky as sex when you are 15 or 35. Those retirement communities and nursing homes had just better wise up. And I can say this because I will be 63 next year. Watch out.

your to funny bear,but i know you older people still want some love and respect,but are you saying your heading into a nursing home?i hope not,your to young man.i do beleive there should be some kind of responce from the government and pramicutical companies as well as the insurance companies before anything like this can be implementing.also civil rights to privacy and consent for medical work has to be AGREED APON BEFOR THEY ARE ABLE TO JUST START TAKING SAMPLES.and if they do something like this then it will hurt the economy which is where i see the politicians get involved and screw it up.just my thoughts i could be wrong again.ojh and not to forget at 64 your more at risk of problems,broken hips and all that stuff take care

[Sky]

They should have been doing this all along. 

[RapidRod]

After 64 most can't see, can't hear and use Viagra. The doc knows to keep testing them till the Viagra doesn't work. If they get alzheimer's, they would forget before they got that far.

[J.R.E.]

Hi Jody,

Thanks for posting this. I had made a brief comment about this less than 2 weeks ago. If someone had asked me in 1985 ( when I was diagnosed positive) if there should be a routine screening, my answer would have been no !! I am only going to be brief here, as I really should be getting myself in bed, so I can get to work tonight at least half alert !!

However I very much do believe in some sort of routine HIV testing being done today. I was able to test anonomously back in 1985, at the county health department...


On that note there was this article that I had seen today on "The Body Pro"

New CDC HIV Testing Recommendations Could Compromise Patients' Civil Rights, ACLU Statement Says


The U.S. Centers for Disease Control and Prevention’s (CDC's) revised recommendations on HIV testing in the U.S. -- that say HIV tests should become a routine part of medical care for residents ages 13 to 64 and that requirements for written consent and pretest counseling should be dropped -- could harm the health and civil rights of people who receive the tests, the American Civil Liberties Union (ACLU) said in a release, CQ HealthBeat reports. The recommendations, published in the Sept. 22 edition of CDC's Morbidity and Mortality Weekly Report, say health care providers should continue routine HIV testing unless they establish that less than one of every 1,000 patients tested is HIV positive, "at which point such screening is no longer warranted." "CDC should be commended for trying to increase the number of people tested for HIV, but eliminating the only safeguards that guarantee that testing is voluntary and informed does little to ensure that people will receive the care they need," Rose Saxe, a staff attorney with the ACLU AIDS Project, said, adding, "Without pre- and post-test counseling requirements, we risk losing a critical opportunity to educate people about HIV and how to prevent the spread of it. Saxe said privacy could be compromised under the guidelines because most states collect the names of HIV-positive people and "[m]any states also require doctors to report private information, such as drug use and sexual history about those who test positive."
9/25/06






Ray