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18 April 2005
HIV Testing Should Be Routine, Say Physicians

Physicians and researchers from Emory University School of Medicine, Brown Medical School, and the Johns Hopkins School of Medicine, say that HIV testing should be routine for all sexually active individuals and offered in emergency departments, jails and substance abuse centers. The proposal for routine testing, appearing in the journal Clinical Infectious Diseases, is based on a review of surveillance reports and recent research data. The recommendation comes at a time when heterosexual HIV infection rates are on the rise in many Western nations.

According to the Foundation for Retrovirology and Human Health, approximately 250,000 people in the United States infected with HIV do not know they are infected. "We see people diagnosed for the first time every month. It's astonishing that opportunities have been missed to diagnose the patient previously. Either the physician or the patient doesn't think of it," says researcher Curt G. Beckwith, a physician at Brown Medical School. "For anybody who is sexually active, this should be a routine part of primary care."

"We are missing opportunities to diagnose HIV infection before individuals develop AIDS, when we can offer counseling about secondary prevention and risky behaviors, begin antiretroviral therapy and help prevent opportunistic infections," says co-researcher Carlos del Rio, at Emory University School of Medicine. "Many people who engage in risky behaviors are reluctant to tell their healthcare providers and may not request HIV testing," says del Rio. "People infected through heterosexual transmission, particularly adolescents, often do not consider themselves to be at risk and do not seek testing on their own. Health care providers also may not elicit accurate information about risk. Routine testing would decrease the stigma of requesting or accepting an HIV test."

Current recommendations for testing in high-prevalence areas - where HIV infection is greater than one percent - and testing based on risk assessment are impractical and inaccurate, the research team reports. Most health care providers do not have access to estimates about prevalence in their particular area, and often it is difficult to determine the risk of HIV infection in individual patients.

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