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Doctors Call for Opt-out Approach to HIV Testing

for public and individual health, we believe the effectiveness and feasibility of expanded opt-out testing should be seriously assessed, they conclude.

In the second article, researchers look at the situation in France, where the rate of HIV testing is among the highest in Europe, but 40% of people are still not diagnosed until the disease is advanced, either with AIDS or with a low CD4 cell count.

Therefore, of the estimated 7,000 people newly diagnosed with HIV in France in 2004, 3,000 may have advanced disease.

This has a major impact on death rates and the spread of infection, say Cyrille Delpierre and colleagues. Each year, one fifth of HIV infected patients' deaths were patients who had discovered their infection in the year before their deaths.

While the current policy in France successfully targets at risk groups, they say it fails to reach low risk groups, who tend to be older, mainly men, heterosexual, with a partner and children. Low risk groups are the most likely to test late.

They say late testing could play an important role in the spread of the infection. Studies suggest that if someone knows they are infected they are more likely to use preventative measures, such as using a condom.

Late testing could also be associated with greater costs in hospital care and the management of opportunistic infections. Catching these people earlier could, they say, lead to a reduction of 31% a year in the number of new sexually transmitted infections.

They therefore recommend expanding routine voluntary HIV testing to all primary health care settings.

An accompanying editorial argues that a more precise goal for any changes in policy should be to reduce the average time between infection and diagnosis.


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