Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
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Miami Herald - April 18, 2003
Connie Prater, cprater@herald.com
"Our prevention efforts have stalled," said Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, which is sponsoring the initiative. "We are not making the kind of progress that we would like. This is an intolerable situation."
An estimated 200,000 untested Americans have the human immunodeficiency virus and are unknowingly spreading it -- increasingly to heterosexual partners. Miami ranks No. 2 in the nation for the number of new HIV cases, while Fort Lauderdale and West Palm Beach are in the top 10.
The solution, Gerberding said, is to make HIV testing part of routine medical care, similar to tests done for hypertension or heart ailments.
'HIV testing is not routinely done in doctors' offices," said Marlene LaLota, program administrator for the Florida Bureau of HIV/AIDS in Tallahassee. "That is absolutely not happening and that's going to require a lot of education."
Florida law requires doctors to offer HIV testing and counseling to pregnant women on their first prenatal office visits and again at 28 to 32 weeks of pregnancy. But the tests are not mandatory.
The CDC wants doctors to push harder to get all expectant mothers tested and do routine screening on infants whose mothers refuse. The goal: reduce mother-to-child transmission from about 300 cases per year.
"We can really prevent perinatal transmission of this infection," said Dr. Mary Jo O'Sullivan, an obstetrician who treats HIV-infected mothers at the University of Miami/Jackson Memorial Medical Center in Miami. She said 98 percent of her patients consent to testing, but the CDC program would catch the small number who refuse.
Studies have shown that babies given anti-retroviral drugs within 24 hours of delivery have a 50 percent chance of avoiding HIV.
For adults, the CDC is pushing a new, rapid test that would be administered in clinics, jails and homeless shelters. The CDC and state health departments are rolling out the test, which costs $12.25. It potentially cuts the turnaround time from two weeks and two visits to the doctor to 20 minutes and one counseling session.
"People get tested all the time," said Yolanda Davis-Camacho, a field-case manager for the Comprehensive Drug Research Center at the University of Miami. "They just don't return for the test results."
Dr. Harold Jaffe, director of the CDC's National Center for HIV, STD and TB Prevention, stressed the test is a screening measure. False positive readings are possible and would be sent to a lab for confirmation. Those results would be available two weeks later.
"A person would not be told on their first visit that, 'You are infected,' " he said.
None of the strategies announced Thursday is mandatory, and several already are in place in Florida, but Gerberding said she hopes they will help reduce the nation's 40,000 new HIV cases annually, a constant for the past decade. The CDC is hoping to spend $35 million for the programs, Gerberding said.
But members of the Tampa-based Florida AIDS Action group expressed concern whether that was enough.
"Once we diagnose all these folks, how do we care for them in a system that is already at the brink?" asked Dr. Gene Copello, executive director of the nonprofit statewide group. "The question of funding HIV/AIDS treatment and care at adequate levels must be addressed in order for this plan to succeed."
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