Another obstacle to routine screening for HIV is about to fall, this time for the Department of Veterans Affairs, the nation's largest provider of HIV care. You may recall that in 2006, the Centers for Disease Control and Prevention issued revised recommendations for testing adults, adolescents and pregnant women for the virus that causes AIDS.
The new recommendations, while acknowledging that 38% to 44% of adults in the U.S. have been tested for HIV, are aimed at the approximately 25% of HIV-positive Americans who are unaware that they harbor the virus. So -- in bureaucratic lingo -- the CDC switched to an opt-out, rather than an opt-in, recommendation. What that means to people who go to hospitals, emergency rooms, clinics and other healthcare settings is that AIDS was to be treated like any other disease when it came to testing.
AIDS testing was to become more like Pap test screening for cervical cancer, or blood pressure readings to check out the heart. Patients have the right to say "no" to such screenings in a medical setting, but if they don't object -- or opt out -- a simple explanation from the physician acknowledged by the patient is enough to grant permission. The CDC said in 2006 that it was time to treat AIDS the same way. Specific signed consent for AIDS screening should no longer be required.
Since the early days of the AIDS epidemic in the 1980s, the disease had different rules from those of most others. Because of the stigma and potential for discrimination associated with the disease, along with the fact that until 1996, there was very little in the way of treatment to slow down the progression from HIV to AIDS to death, federal recommendations were that patients could not be subjected to testing for the disease unless they expressly asked to be tested -- or opted in.
But a CDC report found that of all HIV infections reported in 2004, 40% progressed from HIV-positive to AIDS within a year of diagnosis. That means they've been HIV-positive for a long time. Since the average time from infection with the virus to onset of the disease is about seven to nine years, a lot of infected people are out there, possibly spreading the disease without even knowing it. And the average survival rate is about 11 years longer when people with AIDS are diagnosed early.
The CDC wanted more people to know their HIV status, but that has meant that 20 states had to re-write their laws, eliminating a need for separate written consent for HIV testing. So far, 11 of the states with restrictive HIV-testing laws, including California, have passed new laws removing those barriers.
Now Congress has passed a law removing the barrier to opt-out testing from the VA, according to a news release from OraSure, maker of a rapid results HIV test. It's expected to be signed into law soon, meaning more veterans will be routinely screened.
It's been two years since the CDC recommended that adults 13 to 64 get routinely screened for HIV, according to an article in the Aug. 27 Journal of the American Medical Assn., and there are still problems. AIDS discrimination is still real, some insurers won't cover HIV-screening and many hospital emergency rooms simply don't have the time, personnel and resources to do routine screening on everyone who comes in the door.
But now there's one less barrier to identifying the 250,000 to 312,000 Americans who are HIV-positive and don't know it.
-- Susan Brink
-- Photo Illustration: Getty Images