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Bush Administration to Suggest Routine AIDS Testing Procedures

By Ceci Connolly
THE WASHINGTON POST -- The nation’s top public health doctor, declaring current AIDS prevention programs a major disappointment, announced Thursday the Bush administration will begin encouraging doctors to offer routine HIV testing to all their patients, especially pregnant women.

The new screening procedures, which will be voluntary, are aimed at curbing the 40,000 new infections in America each year, said Julie Gerberding, director of the Centers for Disease Control and Prevention.

“We are not achieving the overall progress we intended to achieve with HIV prevention,” she said in announcing the $35 million initiative. Most alarming, she said, is the large number of Americans who are totally unaware they have been infected with the deadly virus that causes AIDS.

“It is tragic and really unacceptable (that) 200,000 people in this country are HIV positive and don’t know it,” she said. “It is unacceptable that we are 22 years into the AIDS epidemic and we cannot accurately identify the incidence of infection in this country.”

Life-extending medications have drastically reduced the number of AIDS deaths in the past two decades, from about 51,000 in 1995 to about 16,000 in 2001, according to CDC figures. But with prevention efforts stalled, the number of HIV infections has remained steady and some indicators suggest it could soon rise.

Officials fear a recent spike in syphilis cases in gay men signals a likely future jump in AIDS, since both diseases can be spread through unprotected sex and often occur concurrently.

“We are worried about trends we are seeing in urban communities and among men who have sex with men,” Gerberding said in an interview, adding that the syphilis outbreak “could be a harbinger of a much broader expansion in the future” of HIV infection.

Although the guidelines are only advisory, CDC intends to give grants to states and groups to pursue the new strategies, including in jails, homeless shelters and other unconventional settings. The shift in priorities could mean a loss of federal money for organizations that target high-risk groups through programs such as public service campaigns, condom distribution and community workshops, said Ernest Hopkins, director of federal affairs for the San Francisco AIDS Foundation.

In its prevention plan, CDC sidestepped politically thorny questions around safer sex practices, needle exchange programs and abstinence-until-marriage education. The agency has yet to work out many details, including how it will go about placing greater emphasis on identifying and treating partners of HIV-infected individuals.

The recommendations received muted praise Thursday from many involved in AIDS prevention work. While sharp political divisions remain over the Bush administration’s overall performance on AIDS and its sensitivity to privacy concerns, most activists applauded the effort to increase testing.

Until now, CDC had recommended testing patients in acute care hospitals with large numbers of AIDS cases or clinics that specialized in treating sexually-transmitted diseases.

As part of that effort, CDC is loosening requirements that doctors provide extensive pre-test counseling. Some physicians describe the counseling as a barrier to testing, complaining that it takes too long and is not reimbursed by insurers.