3. Promoting HIV Testing in Diverse Populations
Summary
Over the years, the demographics of the US HIV epidemic have evolved substantially, with increasing proportions of newly diagnosed cases occurring among African Americans, Hispanics, and women. These changes have implications for how HIV screening efforts are most effectively conducted—as well as for testing recommendations published by the US Centers for Disease Control and Prevention. In 2005, the CDC undertook a thoroughgoing review of its recommendations for HIV testing in healthcare settings by seeking input from a wide range of stakeholders: healthcare providers, representatives from public health agencies and community organizations, and HIV-positive individuals. Finally, after peer review and further input during a series of national meetings, in September 2006, the CDC issued the current recommendations, with refinements based on comments from these constituencies.
These 2006 recommendations advise that all patients 13 to 64 years of age in healthcare settings should be tested for HIV infection at least once in their lifetimes. This marked a change in focus toward an increased stress on greater access to HIV testing and on providing prevention and care services for HIV-positive individuals, with a view toward reducing new infections and increasing access to HIV medical care for more individuals.
Practically speaking, the current recommendations mean that healthcare providers should offer routine screening for HIV infection to all patients in that age range unless the prevalence of undiagnosed HIV infections in their patient population has been shown to be < 0.1%. In the absence of data on HIV prevalence in a particular area, individual providers and provider organizations should offer voluntary screening until data that demonstrate the presence of < 1 HIV-infected case per 1,000 patients screened, at which level routine HIV screening is no longer warranted. A key aspect of these recommendations is that HIV testing should now be considered to be one more part of routine medical care and that it should be provided on an “opt-out” vs the earlier “opt-in” basis—that is, patients should be informed that HIV testing will be performed along with other routine tests unless they choose not to allow it to be performed.
