Monica Sweeney of New York City's Department of Health says the most at risk of getting HIV have limited access to medical care and don't find out they are infected until they already have full blown AIDS.
"That means for eight to 10 years they have been giving out HIV, having behaviors that transmit it and many times without their knowledge," Sweeney said.
To combat that, the Centers for Disease Control recommends identifying new cases by systematically testing every patient who steps into an emergency room. But New York and nine other states are in direct conflict with those guidelines. They mandate what's known as "informed consent," which means health care professionals must explain the test and get the patient's signature, reports CBS News correspondent Priya David.
Saint Vincent Hospital's Dr. Antonio Urbina has been pushing for testing reform because he says informed consent has become a barrier to stopping the virus.
"Anything we can do to normalize testing will increase patients accepting HIV and increase our ability to diagnose it," Urbina said.
But some advocacy groups say informed consent doesn't prevent testing, rather, it helps patients understand their treatment options if they test positive.
"Just saying to someone 'Here's a test, here's a result,' does not make them go into care, does not make them disclose who they are sexually involved with or change behavior," said Marjorie Hill, the CEO with Gay Men's Health Crisis.
But a few hospitals, like one in the Bronx borough of New York have found a way to work within the current rules, and even use modern technology to vastly increase the number of patients tested.
Patients give information through a computer - and doctors say patients feel more comfortable this way.
Since Jacobi instituted its streamlined program and added the computerized consent form three years ago, it's tested more than 26,000 patients and diagnosed 150 with HIV.
"We are finding positive patients who are unaware of their disease status," said Dr. Yvette Calderon, with the Jacobi Medical Center in the Bronx. "That's huge."
A bill to eliminate written informed consent was recently introduced in the New York State legislature.