The radical change to HIV testing guidelines will be released in June or July, says Kevin Fenton, MD, PhD, the new director of the CDC's National Center for HIV, STD, and TB Prevention. Routine HIV tests in doctors' offices and clinics will no longer require the pretest counseling now a part of all HIV testing.
Fenton, joined by former CDC AIDS chief James Curran, MD, MPH, now dean of Emory University's Rollins School of Public Health, spoke today at a news conference marking the 25th anniversary of the AIDS pandemic.
"Most HIV is transmitted by the 25% of infected people who do not even realize they are infected," Fenton said. "We need to dramatically expand access to HIV testing by making it a routine aspect of clinical care."
Fenton said current guidelines make it impossible for busy doctors and nurses to offer routine HIV tests. That, he says, is because the guidelines call for detailed pretest counseling.
Because HIV testing has never been routine, people who ask for the tests usually have a reason to suspect they may have been exposed to the AIDS virus. The counseling includes safe-sex information. It warns people who test negative to improve their safe-sex behavior. And it helps prepare people who test positive for what will be a lifetime of medical care.
Routine testing in a medical setting, Fenton says, is a horse of a different color.
"What we want to do is to address barriers to testing in clinical sites," Fenton says. "We know that a barrier is the significant time it takes for pretest counseling. … HIV testing outside clinical settings will still bear the requirement for pretest counseling."
Timothy Mastro, acting director of the CDC's Global AIDS Program, says the idea is to make more people -- a lot more people -- aware of their HIV status.
"These new guidelines … recommend [changing] the nature of HIV testing so that it's not based on the risk to an individual or the community in which an individual resides, but routinizes testing of all people between the ages of 13 and 64," Mastro said at the news conference. "People with ongoing risk behaviors should be tested more frequently, but we think everyone should be tested at least once in the 13- to 64-year-old age group."
Testing is part of what disease trackers call surveillance -- the public health equivalent of knowing your enemy. Curran calls it the most important tool in fighting AIDS.
"Surveillance was the most important thing early in the epidemic," Curran said. "It continues to be the most important thing in designing and targeting prevention efforts to those most at risk -- and evaluating the extent to which those efforts are effective."
U.S. AIDS at 25
The CDC news conference focused on AIDS in America. But Curran stressed that HIV is a continuing worldwide disaster on an unprecedented scale. We forget this at our peril, he says.
"It is difficult to reflect after 25 years, back to June of 1981, to understand how something that began so quietly can be the fourth leading cause of death in the world," Curran said. "[AIDS is] something that is continuing to grow, with 2 million more people that are dying each year. It is something that seems to know no bounds in its stretch around the world -- causing 40 million human incubators carrying other infectious diseases. Something we thought was a small problem back then."