Washington Blade - February 6, 2009
James Driscoll, Ph.D.

The U.S. is at war with AIDS on the home front. We are losing this war. In the gay community, among blacks, and in Washington itself, the HIV incidence rate approaches sub-Saharan levels and new infections are increasing.

What can the Obama administration do to turn the tide against HIV in America? The indispensable first step is increased HIV testing. We must test more people, test more often, target high incidence groups and geographic areas, use the latest technologies and make sure that all new HIV positives are linked to quality care.

Patients who know they have HIV usually try to avoid infecting their partners. Moreover, HIV medicines lower patients' viral loads, reducing their likelihood of infecting others. Because HIV is contracted from persons who have it, there is no more efficient and effective way to prevent new infections than rendering people with HIV less infectious.

The CDC estimates that at least 21 percent of the 1.1 million Americans with HIV do not know they are infected. This dangerous reservoir of untested HIV positive people is the source of at least 55 percent of new infections. Untested positives are 4.6 times more likely to spread their disease. If the majority of them could be tested, new infection rates might be cut by more than 12,000 cases per year.

RECENT STUDIES INDICATE that CDC's routine testing initiatives are lagging. CDC testing guidelines must be more aggressively implemented, which will require more federal resources.

Because of insufficient testing, rising percentages of new HIV-positive cases are tested only after their disease is seriously advanced. HIV treatment is most successful when begun early. As with cancer, early diagnosis and treatment are critical in the war against AIDS. To start winning we must test much more often, focus on the most vulnerable groups and make sure that all who test positive have ready access to quality HIV care and drugs.

The lifetime cost of one HIV case is estimated to exceed $500,000. Reducing new infections by 12,000 would save the United States $6 billion in long-term costs each year. Investing 5 percent of those potential savings in targeted testing would go far toward reducing the infection rate.

How do we insure that additional testing funds will be spent wisely? First, we must implement current CDC guidelines for routine testing in healthcare settings such as community clinics and all emergency rooms. Rapid testing and other new technologies must be intensively deployed with special populations such as MSM, IV drug users and prisoners. Medicaid and private insurance must reimburse for routine HIV testing.

We will need to increase the base funding for community healthcare centers, like those in the Ryan White AIDS Program, so they can do more testing and link to treatment and care those who test positive. We should also give these centers incentives to encourage finding more HIV positives.

PRESIDENT OBAMA AND Congress plan to spend vast sums to stimulate our ailing economy. This endeavor poses both pitfalls and great opportunities. Increased HIV testing and care is an especially promising stimulus opportunity. It exemplifies smart spending. Testing will move money quickly to meet the urgent needs of some of our most unfortunate citizens.

America can spend the stimulus stupidly on dubious projects and wasteful pork. Or we can invest wisely to strengthen our infrastructure as President Obama says he wants to do. America's most crucial infrastructure is our human infrastructure. The human infrastructure depends on environment, education and healthcare. There is no smarter healthcare investment than getting all HIV positive Americans tested and into treatment.

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James Driscoll, Ph.D., is a Washington-based consultant to the AIDS Healthcare Foundation and a former member of President Bush's Presidential Advisory Council on HIV/AIDS.

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