United Press International - October 23, 2006
Christine Dell'Amore

The Washington hospital will begin posting HIV screening liaisons in each department to administer free, voluntary HIV tests. The staff will use Food and Drug Administration-approved OraQuick Advance, a saliva-based test that determines a person's HIV status within 20 minutes.

All patients will be offered the free test, but they will have the choice to verbally opt out, said Dr. Celia Maxwell, director of the hospital's Center for Infectious Disease Management and Research. Maxwell added she doesn't expect many people to opt out, as most want to know the status of their health.

"It's my hope this becomes like a cholesterol test -- just a standard routine (given) by your doctor," Maxwell told United Press International at a launch kick-off at the hospital. HIV/AIDS "should be destigmatized, because this is a disease like any other."

The district has the highest rate of AIDS in the country: New AIDS cases hit 179.2 per 100,000 residents in 2004, vs. 15.0 cases per 100,000 nationwide -- surpassing rates of some sub-Saharan countries. There are approximately 40,000 to 45,000 new cases of HIV diagnosed nationwide each year, mostly under the ages of 25.

The screening program comes in response to Centers for Disease Control and Prevention recommendations, issued in June, that HIV testing be included as part of regular health screening for Americans. Although the CDC suggested testing Americans 13 to 64, the D.C. government has advocated increasing the age of screening to 84.

Maxwell and colleagues modeled the screening program after ACTS, a rapid, simplified screening prototype developed by the Montefiore Medical Center in New York. ACTS -- which stands for assess, consent, test and support -- takes no more than five minutes, and can be quickly diffused into healthcare settings. Randomized trials currently under way in South Africa, which has also adopted the program, and the Bronx show ACTS has doubled HIV testing rates.

Previous research has shown patients who are HIV-positive and know their status reduce high-risk sex by 50 percent, Maxwell said. Likewise, people who get screened and test negative may start thinking about it, and engage in behaviors to keep them healthy, Maxwell speculates.

"Either way, it's a win-win," she said.

She also anticipates that screening and identifying people with HIV early, before their syndrome progresses into full-blown AIDS, will be a great cost advantage to hospitals and healthcare centers. Those D.C. residents who test positive will be referred to the hospital's infectious-disease center for secondary testing and follow-up care -- including those without health insurance.

The city government has also spearheaded a campaign to get all residents between the ages of 14 to 84 screened for the virus by Dec. 31, 2006.

"This is absolutely a historic moment," said Leo Rennie, bureau chief for HIV prevention at the city's Administration for HIV Policy and Programs. "This is new and innovative -- we're ahead of the CDC guidelines."

The AHPP, led by Marsha Martin, has taken a more vigorous approach to combating HIV/AIDS following a period of relative stagnancy.

Jeanne White Ginder, mother to the late Ryan White, the outspoken teen who died of AIDS in 1990, also spoke about her son's struggle with discrimination -- still a major barrier to bringing HIV/AIDS out of the shadows and into the public dialogue. The resulting Ryan White Care Act of 1990 remains one of the largest federally funded programs to treat people living with HIV/AIDS.

"People with AIDS need to go on with their daily lives," said White Ginder, who has followed in her son's footsteps as an AIDS activist. "As Ryan used to tell me, 'Let's make it a disease, not a dirty word.'"

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