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CDC Urges Widespread HIV Testing For Teens and Adults

By Donald G. McNeil Jr.
THE NEW YORK TIMES

The U.S. Centers for Disease Control and Prevention, in a major shift of policy, recommended Thursday that all adults and teenagers should have HIV tests as part of routine medical care, because too many Americans are infected with the AIDS virus without knowing it.

The recommendation urges testing, at least once, for everyone from 13 to 64 and annual tests for those with high-risk behavior.

The proposal is a sharp break from policies set by more than two decades in which the stigma of HIV and limits in treating its effects caused many people to avoid being tested and led to heated debate about whether positive test results could be shared by medical and governmental authorities in their effort to contain the epidemic by reaching out to partners of those who might be infected.

Rose A. Saxe, a staff attorney with the AIDS Project of the American Civil Liberties Union, raised concerns about privacy, saying that in virtually every state, doctors must report the names of everyone infected with HIV, and many require reporting information like drug use and sexual history.

Under the agency’s plan, patients would be told they are being tested, but the tests would be voluntary. To permit the tests to be easily administered, however, the agency urged the removal of two major barriers: separate signed consent forms and lengthy counseling before each test. That would require new laws in some states, however, a process that could take years because some civil liberties groups and lobbyists for people with AIDS oppose the changes.

Many doctors, however, are expected to welcome the changes. “These recommendations are important for early diagnosis and to reduce the stigma still associated with HIV testing,” said Dr. Nancy Nielsen, a board member of the American Medical Association, which endorsed the new guidelines.

Dr. Julie Gerberding, the CDC’s executive director and herself a doctor who treated some of the first San Francisco AIDS patients in 1981, said: “Our traditional approaches have not been successful. People who don’t know their own HIV status account for 50 to 70 percent of all new infections — if they knew, they would take steps to protect themselves and their partners.”

The new guidelines, if adopted, would move the agency toward its “ultimate goals,” which Gerberding described as: no more infected children, no one living for years without antiretroviral treatment and, eventually, no more new cases of the disease. About 40,000 Americans are newly infected each year, and the number is remaining steady. In contrast to the early days of the epidemic, which struck gay men the hardest, many of those now afflicted, including teenagers, were infected by heterosexual activity. The black and Hispanic communities have been particularly hard hit. The agency estimates that 250,000 Americans — a quarter of those with the disease — do not know they are infected.

Moreover, 42 percent of those who find out they are infected are tested only because they are already seriously ill — which means they have been infected for up to 10 years and may have been passing the infection on all that time, Gerberding said.