United Press International - April 17, 2003
Steve Mitchell, UPI Medical Correspondent

The aim of the initiative is to "open up the doors to testing so that people can learn their (HIV) status and get the appropriate prevention and treatment services they need," CDC Director Dr. Julie Gerberding said during a teleconference from Atlanta.

The reason for the change now is "prevention efforts have stalled," Gerberding said. "We are not making the kinds of ongoing progress in reducing (the number of) patients we would expect to be able to achieve, given some of the recent advances in testing technologies," she said.

More than 800,000 people are infected with HIV in this country but about 200,000 do not know it and thus "are not getting appropriate treatment for their HIV infection," Gerberding said. "This is an intolerable situation in the minds of public health officials."

To make HIV tests more accessible, the CDC will remove the requirement from its guidance that extensive prevention counseling be offered by physicians or healthcare organizations testing people for HIV.

Counseling "is still critically important" because it helps people change their behavior and reduce their risk, but it is a barrier to getting tested because many physicians don't have the time or training to do the counseling, Gerberding said.

Physicians will be advised to make the HIV test part of routine medical care. Doctors should offer the test to people living in areas where the disease is highly prevalent or those who are members of high-risk groups, such as men who have sex with men, people who engage in unsafe sex or those who use intravenous drugs, she said.

HIV testing will now become part of the routine perinatal screening of pregnant women. Each year, about 300 infants contract HIV from their mothers. "Each case of perinatal transmission really represents a failure of the public health system," Gerberding said.

"Mothers can decide not to have the test ... but we want to make sure their children are tested after birth so we can make life-saving treatments available to them," she said.

Gerberding acknowledged that this raised ethical issues "if the child is tested automatically by the state ... when the mother has refused." But she emphasized that the "CDC is not recommending mandatory testing of any group of people under any circumstances."

Gerberding did not detail how the infant screening program might work because it will be up to the individual states to come up with their own strategies. "From a CDC perspective, we're not very interested in how people accomplish this as long as it's done in a very fair and humanitarian way, but we are interested in that we don't miss any kids," she said.

The CDC initiative also aims to increase use of a new rapid HIV test called OraQuick that was recently approved by the Food and Drug Administration. The test yields results in about 20 minutes.

The CDC will fund projects to put the rapid test into use in areas where there is a high prevalence of HIV infection, including prisons and other nonmedical settings such as drug-addiction treatment clinics.

Another component of the CDC initiative focuses on changing the behavior of those infected with HIV but who are not receiving appropriate medical care. This will include distributing new guidelines for changing patient behavior to physicians and infectious disease specialists. The CDC will also put more emphasis on notifying partners of those infected with HIV and offering the rapid HIV test to these people.

Tom Coates, professor of medicine and director of the AIDS Research Institute at the University of California at San Francisco, said making HIV testing more routine could be beneficial.

"On the other hand, I worry that it's a way of trying to do things more on the cheap and ... overlooking some of the problems," Coates told United Press International.

Lack of health insurance is a bigger barrier to HIV testing and treatment, Coates said. Those most at risk for HIV infection -- impoverished ethnic minorities -- often do not have access to healthcare because they do not have health insurance.

People aren't refusing to get tested, they simply don't have access to healthcare facilities that offer testing and treatment, he said, noting that the CDC initiative does not do much to address this primary problem.
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