The New York Times - October 3, 2006
Richard Perez-Pena

The steep increase actually began two years ago, primarily at the Rikers Island jail complex, then spread to clinics and hospitals. It was aided by new tests, introduced in 2003, that produce results in minutes rather than days, and by a rule adopted last year by the state Department of Health that reduced the amount of counseling required before a test.

The city's Health and Hospitals Corporation tested 92,000 people in the year ended June 30, up from 58,000 the previous year, and testing is running at an annual pace well over 100,000, said Alan D. Aviles, president of the corporation.

Until last year, he said, most of the people tested in the corporation's hospitals and clinics were pregnant women - the one population for whom testing is nearly universal, but one that is not at particularly high risk of infection with H.I.V., the virus that causes AIDS.

"The big change here has been we're trying to move toward normalizing the testing by offering it in other settings - in inpatient units, in emergency departments and in select outpatient clinics," in all 11 hospitals and 5 large family clinics, Mr. Aviles said.

That has allowed the corporation to diagnose H.I.V. in more people who were at high risk but had not sought out a test. The change was reflected in the fact that the number of positive tests more than doubled, to 1,520 from 720.

In some hospitals, as many as 4 percent of the people tested were infected with the virus.

The city's Department of Health and Mental Hygiene tested 52,000 people in its 10 sexually transmitted disease clinics in 2005-6, up from 42,000 the year before. And at Rikers Island, it screened 29,000 prisoners, compared with 17,000 a year earlier, and 5,000 the year before that.

The federal Centers for Disease Control and Prevention recently adopted a stance much like the city's, saying that H.I.V. tests should be suggested much more often, that everyone over age 13 should be tested at least once, and that some sexually active people should be tested annually.

The increase in testing by the city, sharp as it is, indicates how remote such goals remain. The agencies screened 173,000 people in a year, in a city of more than eight million. Officials do not know how many people are tested by private hospitals, doctors or community groups, which are required to report only the number of infections they find.

City officials have campaigned to change a New York State law that requires counseling before and after H.I.V. tests, and requires that the patient sign a written consent form that deals solely with that test and its implications. The Centers for Disease Control recommendations cannot be carried out with that law in place, and it has recommended that such restrictions be removed. But some state lawmakers and advocacy groups for people with H.I.V. want to keep them.

Dr. Thomas R. Frieden, the city health commissioner, said the increased testing at city hospitals, clinics and jails represents the city's attempt to see what it can do within the confines of existing state law.

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