Another obstacle to routine screening for HIV is about to fall,
this time for the Department of Veterans Affairs, the nation's
largest provider of HIV care. You may recall that in 2006, the
Centers for Disease Control and Prevention issued revised
recommendations for testing adults, adolescents and pregnant
women for the virus that causes AIDS.
Aids2 The new recommendations, while acknowledging that 38% to
44% of adults in the U.S. have been tested for HIV, are aimed at
the approximately 25% of HIV-positive Americans who are unaware
that they harbor the virus. So -- in bureaucratic lingo -- the
CDC switched to an opt-out, rather than an opt-in,
recommendation. What that means to people who go to hospitals,
emergency rooms, clinics and other healthcare settings is that
AIDS was to be treated like any other disease when it came to
AIDS testing was to become more like Pap test screening for
cervical cancer, or blood pressure readings to check out the
heart. Patients have the right to say "no" to such screenings in
a medical setting, but if they don't object -- or opt out -- a
simple explanation from the physician acknowledged by the patient
is enough to grant permission. The CDC said in 2006 that it was
time to treat AIDS the same way. Specific signed consent for AIDS
screening should no longer be required.
Since the early days of the AIDS epidemic in the 1980s, the
disease had different rules from those of most others. Because of
the stigma and potential for discrimination associated with the
disease, along with the fact that until 1996, there was very
little in the way of treatment to slow down the progression from
HIV to AIDS to death, federal recommendations were that patients
could not be subjected to testing for the disease unless they
expressly asked to be tested -- or opted in.
But a CDC report found that of all HIV infections reported in
2004, 40% progressed from HIV-positive to AIDS within a year of
diagnosis. That means they've been HIV-positive for a long time.
Since the average time from infection with the virus to onset of
the disease is about seven to nine years, a lot of infected
people are out there, possibly spreading the disease without even
knowing it. And the average survival rate is about 11 years
longer when people with AIDS are diagnosed early.
The CDC wanted more people to know their HIV status, but that has
meant that 20 states had to re-write their laws, eliminating a
need for separate written consent for HIV testing. So far, 11 of
the states with restrictive HIV-testing laws, including
California, have passed new laws removing those barriers.
Now Congress has passed a law removing the barrier to opt-out
testing from the VA, according to a news release from OraSure,
maker of a rapid results HIV test. It's expected to be signed
into law soon, meaning more veterans will be routinely screened.
It's been two years since the CDC recommended that adults 13 to
64 get routinely screened for HIV, according to an article in the
Aug. 27 Journal of the American Medical Assn., and there are
still problems. AIDS discrimination is still real, some insurers
won't cover HIV-screening and many hospital emergency rooms
simply don't have the time, personnel and resources to do routine
screening on everyone who comes in the door.
But now there's one less barrier to identifying the 250,000 to
312,000 Americans who are HIV-positive and don't know it.