In a Significant Policy Shift, the CDC Recommends HIV Testing for All Americans Aged 13 to 64

On September 21, 2006, the U.S. Centers for Disease Control and Prevention (CDC) issued bold new recommendations regarding HIV testing. These forward-thinking recommendations advance the position that all adolescents and adults aged 13 to 64 and pregnant women should regularly be offered an HIV test in health-care settings--and be given the right to "opt out" of the test. The recommendations do not apply to non-clinical settings, such as publicly funded HIV testing sites and community clinics, where testing is not ordered by a physician.

Since 1985, when the test for HIV infection first became available, Americans have been encouraged to be tested regularly--particularly individuals in high-risk groups, such as gay men and injection drug users. The new recommendations promote population-wide screening in a vigorous effort to identify previously undiagnosed cases of HIV.

The CDC estimates that 25 percent of Americans who are HIV-positive do not know their HIV status, a fact that jeopardizes their own health and the health of their sex and needle sharing partners. Mark Cloutier, the San Francisco AIDS Foundation's Executive Director, said "Our current approach to testing has failed to identify 250,000 HIV-positive Americans and get them into care. Many of the 40,000 new cases of HIV infection that occur nationally each year could be avoided if more HIV-positive people were aware of their HIV status."

The new recommendations suggest that pre-test counseling and separate written informed consent do not need to be made a part of HIV testing. SFAF shares the belief that these requirements have served to limit testing because the time and paperwork they require is burdensome to doctors and patients and discourages medical providers from offering HIV tests.

SFAF has written to the CDC to stress that the new recommendations must be accompanied by an increased commitment on the part of the federal government to assure access to primary medical care and treatment for all Americans who are diagnosed with HIV. "Existing funds are inadequate to fully meet the cost of care and treatment for individuals already known to be HIV positive. The nation must not ignore the many people who will learn that they are HIV positive under this new initiative," said Cloutier.

The CDC has indicated that it still must propose guidelines for implementing its revised recommendations. SFAF will review the proposed guidelines to make sure they guarantee individuals' rights to be informed if an HIV test is to be performed, to have the meaning of the test and its results explained, and to opt out of testing if they so choose.

Because current California law does not require separate written informed consent when a doctor or surgeon tests a patient for HIV, the new recommendations should be easily integrated into the state's health-care system.