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U.S. Lags on HIV Testing Goals
Date:11/20/2008

Despite call for routine exams, 60,000 Americans were infected last year

THURSDAY, Nov. 20 (HealthDay News) -- Two years after U.S. health officials recommended routine HIV testing for Americans 13 to 64, such testing remains hit-and-miss, and the AIDS epidemic marches on.

This, despite the new testing guidelines and better testing methods, according to participants at a conference in suburban Washington D.C. The meeting was designed to review the state of the AIDS epidemic and the unmet role that routine testing can play.

"It's fast, it's cheap, it's easy, it's almost perfect in terms of positive or negative results, and it detects a lethal disease that can now be treated," Dr. John Bartlett, professor of medicine at the Johns Hopkins University School of Medicine's division of infectious diseases, said during a Thursday teleconference. "It's highly cost-effective and it deals effectively with a major public health problem. This is a slam dunk."

More than 1.1 million Americans are now living with HIV, the virus that causes AIDS. And more than 56,000 Americans were newly diagnosed with the virus in 2006, officials said.

"While significant progress has been made in the two years since the U.S. Centers for Disease Control and Prevention recommended routine testing, we are still nowhere near this being the national norm," said Veronica Miller, executive director of the Forum for Collaborative HIV Research, an independent public-private partnership that organized the conference. "Testing for HIV should be as routine as a flu shot, she said.

Testing can save lives.

"Once people learn they are infected with HIV, they take steps to protect their partners," said Dr. Kevin Fenton, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.

The three-day conference pulled together some 300 leading HIV researchers, health-care providers and policymakers to look at the issue of early, routine HIV testing.

Statistics show that before 2006, hospital emergency rooms tested patients for HIV at a rate of just 3.2 per 1,000 visits -- or 0.32 percent. In the two years since, there's been slight improvement, with an estimated 50 to 100 out of 5,000 emergency rooms nationwide routinely testing for HIV, according to Dr. Richard Rothman, of the Johns Hopkins University Department of Emergency Medicine.

A lack of testing occurs in other settings as well, such as correctional facilities and Veterans Administration hospitals. Other research presented at the conference found that just 36 percent of insured individuals seeking treatment for sexually transmitted diseases -- a high-risk group -- were tested for HIV.

And under-testing, of course, means that people who are infected don't start their treatment until later. One study found that 40 percent of patients newly diagnosed with HIV were "late testers," meaning they had AIDS diagnosed within one year of their test.

"Seventy-five percent of those patients had had health-care visits and the most frequent site of visits was the emergency department. There were many missed opportunities," Rothman said.

Despite legislative, medical and social barriers, there have been some successes. They include a voluntary rapid HIV testing program in New York City jails that increased testing from 6,500 to 25,000 inmates between 2004 and 2006. And a Chicago hospital added two health educators to its emergency room, offering rapid testing to patients admitted for medical services. Over 15 months, nearly 2,000 patients were tested, and 15 percent were confirmed HIV-positive. They were set up with care, according to a conference news release.

"I tested positive for HIV 20 years ago and, as a result, have had the opportunity to live a better life and a longer life," said Deadra Lawson Smith, a member of the Living Quilt Project and a community liaison/peer advocate with the South Carolina HIV/AIDS Council.

"People think knowing your status changes your life. It does change your life, but it doesn't change anything else. If you're a mother, you're still a mother. If you're a grandmother, you're still a grandmother. If you're an employee, you're still an employee. If you're a voter, you're still a voter," she said.

More information

To learn more visit the Forum for Collaborative HIV Research.



SOURCES: Nov. 20, 2008, teleconference with John Bartlett, M.D., professor of medicine, division of infectious diseases, Johns Hopkins University School of Medicine; Veronica Miller, Ph.D., executive director, Forum for Collaborative HIV Research; Kevin Fenton, M.D., director, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, U.S. Centers for Disease Control and Prevention; Richard Rothman, M.D., Johns Hopkins University; Deadra Lawson Smith, Living Quilt project member and community liaison/peer advocate, South Carolina HIV/AIDS Council


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