For Americans ages 13 to 64, testing for HIV is expected to become as common as checking for cholesterol and blood pressure with the new recommended guidelines from the Centers for Disease Control and Prevention. The exams will be voluntary, but could wider testing pose risks to your privacy? Will it help get rid of the stigma attached to AIDS?
To get a better grasp of what the new guidelines mean for average Americans, MSNBC.com spoke with Health Commissioner Dr. Thomas R. Frieden of the Department of Health and Mental Hygiene in New York City, which has one of the nation's highest rates of HIV infection.
Q. Why is routine testing so important?
A. More people would learn that they’re infected early, early enough to get care to prevent themselves from getting sick. And also early enough to reduce the likelihood that they would infect their partners.
Q. An estimated 1 million people are living with HIV in the U.S. Are there a lot of people who are unaware that they are infected?
A. The estimate from [the CDC] is that about one-quarter or 1 in 4 people who are HIV-positive are unaware of it. Nationally, about 40 percent of all people who test positive for HIV develop AIDS within one year. Now, it generally takes about 10 years to go from HIV infection to AIDS, so it means that they’ve been around, in and out of many different locations, for many years and never got HIV tested. If they’d been tested, they could have stayed healthy longer and they would have been less likely to infect those around them.
Q. Are there any possible risks to making HIV testing more routine?
A. There are a couple of issues that people are concerned about. One is the possibility that people will be tested without their knowledge or consent. We certainly want to make sure that no one is tested without knowing that they’re being tested and consenting to being tested.
A second concern people have is cost-effectiveness. It costs a lot of money to do all this testing. But that’s been analyzed in two studies in the New England Journal of Medicine which found that testing for HIV is highly cost-effective, much more so than many of the tests that are already routinely done in doctor’s offices.
Q. How likely is it for someone to be tested without their knowledge? Is that a reasonable concern?
A. It’s a reasonable concern. It’s something that we have to safeguard against. We have to balance the theoretical risk that that might happen with the reality that today across the country thousands of people are getting diagnosed with AIDS with not having had the benefit of knowing their HIV status and being able to take action to live longer and healthier themselves.
Q. What type of counseling would be available to a patient who tests positive?
A. The thing we’ve promoted is a restructuring of the counseling and testing experience. Instead of spending so much time counseling the 99 percent of people who test negative we should focus the resources on those who test positive.
We’re not just talking about testing, we’re talking about testing and linkage to care. Anyone who tests positive should be linked to HIV primary care so that they can get into treatment and get the care they need to live longer and healthier.
Q. Would parental consent be required to test sexually active people under age 18?
A. That would depend on different state laws. That’s a state-by-state issue. In New York, diagnosis and treatment of sexually transmitted diseases in minors does not require parental information or consent.
But, with HIV, rates increase with age. So, we’re more concerned about people in their 20s, 30s and 40s than we are about the young kids.
Q. What impact do you expect the new guidelines will have?
A. I hope it will result in the mainstreaming of HIV testing, so that it becomes more part of normal medical care — with the result that more people who are infected find out early and the number of people who only find out they’ve got HIV when they’re already sick with AIDS decreases significantly.
But that will require significant changes in medical practice and in some states like New York significant changes in the law.
Q. What changes?
A. To allow documented oral consent as an acceptable alternative to separate written consent for HIV testing. Now it's a separate process which requires separate written consent. That’s different from everything else in all of medical care. So that ends up being a barrier, not so much for patients as the doctors for whom a separate form and a separate procedure is a reason not to do something that is already somewhat difficult. Because you’re talking about a disease that does still have stigma attached to it.
Q. What difference would oral consent make?
A. It would make it much easier for doctors to offer a patient an HIV test. It would no longer have HIV testing be different from the rest of medical care and it would allow us to mainstream testing for HIV care, thereby helping more people learn their status.
