Miami Herald - September 22, 2006
Jacob Goldstein, jgoldstein@MiamiHerald.com

Public health officials hope that making the test routine will help find some of the estimated 250,000 people who have HIV but don't know it and slow the spread of the disease, which continues to infect 40,000 people each year.

In South Florida alone, which has one of the nation's highest HIV rates, government estimates suggest thousands people are unaware they have HIV.

Earlier guidelines had recommended testing for those known to have risk factors, such as intravenous drug use or a high number of sexual partners.

'REDUCE STIGMA'

"Screening that is universal and not tied to risk behavior will help reduce the stigma associated with HIV testing," said Dr. Timothy Mastro, acting director of HIV/AIDS prevention at the Centers for Disease Control and Prevention, which issued the guidelines.

The new guidelines also do away with old recommendations for extensive pre-test counseling and separate, written consent. Now, it's recommended that HIV testing be covered in general consent procedures. Patients would have the option of skipping the test.

The old recommendations are enshrined in Florida statutes that would have to be changed by the Legislature for the new guidelines to take effect here.

AIDS activists welcomed the move to expand testing but were divided on the call to end pre-test counseling. Their reactions depended on whether they believed HIV is becoming a malady like any other, or remains a disease apart, best governed by its own rules.

"Consent for other diseases falls under this rubric of general medical consent," said Tracy Welsh, executive director of the HIV Law Project, a nonprofit group that has opposed a push to change pre-test counseling laws in New York. "HIV is a different type of disease, both in terms of the public health implication, but also in terms of people fully understanding what it means to be negative and stay negative."

But Rick Siclari, executive director of the Miami-based AIDS group Care Resource, supported the change.

"Maybe five years ago, I wouldn't have agreed with it," he said. "But I really do think we've reached a point in the disease where we've come out of the closet with it."

The changes might be necessary if busy primary-care physicians are going to take the time to test all patients for HIV, said Dr. Mark Multach, chief of internal medicine at the University of Miami.

"It's nice that the CDC says to loosen up these rules, but the reality is that in the state of Florida, obtaining a test is five to 10 minutes [of counseling] beforehand, and another 10 to 15 minutes with the results," he said. 'What the physicians are going to say is, 'Yeah, yeah, yeah, but I know who is at risk for HIV and who's not, and I'm not going to test everybody.' "

INEXPENSIVE

Multach said insurance companies usually cover testing and counseling. The test itself is cheap -- $4 in state labs when the result is negative, according to the Department of Health. (Positive tests require additional, confirmatory work that drives up the price.)

The new guidelines call for offering the test once to those without known risk factors, and more often to those who engage in risky behaviors. South Florida's laboratory capacity should be enough to handle any upswing in testing caused by the new guidelines, said Jolene Mullins, early intervention coordinator for Broward County's AIDS program.

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