Despite federal regulations that virtually all adults be routinely tested for HIV in emergency rooms and doctors' offices, people at risk for contracting the virus are not getting tested, a coalition of researchers and health experts has warned.
The Forum for Collaborative HIV Research, based at George Washington University's School of Public Health, said yesterday that testing is the key to ending the epidemic in the United States. Of the nation's estimated 1.1 million people living with HIV, one in five do not know it and those who are being diagnosed are learning the news too late, the group said.
Those who do not know they have the virus are responsible for transmitting 50 percent to 70 percent of new sexually transmitted infections, the group said.
"It's a call to action that the test will be offered on a more regular basis," said Dr. John G. Bartlett, chief of infectious diseases at the Johns Hopkins School of Medicine and co-chairman of the meeting.
Dr. Kenneth H. Mayer, director of the Brown University AIDS Program, said many of the people who are infected with HIV do not consider themselves high risk and are unlikely to seek testing. For instance, African-American women, who have disproportionately high rates of HIV, are often infected in the context of a monogamous relationship, he said.
In 2006, the Centers for Disease Control and Prevention reported 56,300 new cases in the U.S., reflecting shifting HIV demographics. A quarter were women and a third people younger than 30. Blacks and Latinos accounted for 63 percent of new infections.
The same year, the CDC revised testing recommendations from a focus on at-risk groups to encouraging routine testing of people ages 13 to 64 in all health care settings, asserting that a universal approach would be more effective in prevention.
Experts say widespread testing is not happening because of a lack of health insurance reimbursement and lingering stigma associated with the disease.
Emergency rooms tested patients at a rate of 3.2 per 1,000 visits, according to 2006 data shared at the conference by Dr. Richard Rothman, associate professor in Hopkins' emergency medicine department: "There are many missed opportunities in recognizing patients earlier in the course of their illness."
Still, some cities - including Baltimore - are having success making HIV testing the norm.
This year, the city stopped requiring written consent for HIV testing. "Many felt that the consent was stigmatizing in itself; you don't need a consent form for other blood tests," said Dr. Laura Herrera, chief medical officer for the city's Health Department. "The goal is to normalize it and remove a barrier to HIV testing so the perception is that HIV testing isn't any different than any other testing."
Also this year, the department began working with five city emergency departments to offer rapid HIV tests, which provide results within a half-hour. The program was launched with a grant from the Maryland AIDS Administration.