United Press International -- November 29, 2006
Christine Dell'amore, UPI Consumer Health Correspondent

"We've reached a stone wall," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said at a news briefing.

"As we expose this societal lesion of so many people infected ... we need to take a cold hard look to see if we're doing enough for treatment and prevention."

On the eve of World AIDS Day on Dec. 1, the U.S. HIV rate remains the same as it has for more than a decade; about 1.1 million Americans are now infected.

"There have been 40,000 new cases of HIV each year in the United States for the past 16 years, and that's humbling," said Dr. John Bartlett, director of the AIDS Care Program at Johns Hopkins University School of Medicine in Baltimore.

Although many prevention strategies exist -- circumcision and condom use among them -- few seem to be universally effective.

But routine HIV testing, now possible with quick diagnostic tests, can begin to chip away at the problem, Fauci said.

In June the Centers for Disease Control and Prevention, one of the sponsors of the Washington summit, recommended all Americans ages 13 to 64 have the option of getting an HIV test as a routine part of their healthcare.

A person who knows his or her status is less likely to engage in high-risk behavior, and more likely to seek a physician's care. About 25 percent, or 250,000, Americans are unaware they are infected with HIV. Those blindly carrying the virus are thought to transmit 50 percent to 70 percent of new sexually transmitted HIV infections in the United States.

"I am concerned we could be on the verge of a larger epidemic," said Dr. Michael Saag, professor of medicine at the University of Alabama at Birmingham. As the director of the AIDS Outpatient Clinic in Birmingham, Saag suspects the rate of undiagnosed HIV is higher than 25 percent, both in his clinic and nationwide.

Many experts see treatment in itself as a prevention strategy. If everyone infected with HIV would get care, "there's no question transmission would be reduced substantially," Saag said.

Testing and treating people early for HIV also prolongs life. Saag has found those who get early treatment in his clinic have a mortality rate of 4 percent to 8 percent, as compared to 45 percent to 50 percent for people with late-stage HIV.

"That screams at us we should be testing earlier," Saag said.

But HIV screening has failed to catch on in doctors' offices, hospitals and free clinics. And much of the funding for testing comes from limited federal sources, such as the Ryan White Care Act. Many of those infected with HIV are also unemployed or uninsured, adding a greater burden to clinics reliant on outside funding.

Saag's clinic, for instance, has already hit capacity, and despite an ever-growing caseload, funding has stayed flat for the past seven years.

Some are encouraged by President Bush's 2007 budget, which has allocated $93 million for increased HIV/AIDS testing activities among high-risk populations.

Still, "the question is, can the healthcare system in the United States manage this?" Bartlett said.

In Washington, where the rate of new AIDS cases is the highest in the nation, officials are positioning the city as a model for translating the CDC testing guidelines into action. In June, Marsha Martin, who directs the city's HIV/AIDS Administration, launched a campaign to urge all residents to "know their status" by Dec. 31, 2006.

Since then, the number of healthcare sites providing HIV testing in the district has risen from 17 to 42, a 150-percent increase. As of Sept. 30 more than 16,700 residents have been screened for HIV; 580 have tested positive. That's about a 3.5-percent positive response rate -- three to four times the national average.

There are challenges -- some staff aren't trained to administer the HIV test, for instance -- but Martin told United Press International she "feels great" about the campaign's progress so far.

"We're leading the way," she said.
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