Why Routine Testing Now?
The CDC estimates that 1 in 5 persons living with HIV do not know they are infected.
Applied to Texas, this means that about 15,000 Texans are infected with HIV, but do not know it. Those who are diagnosed often receive that diagnosis after years of living with HIV.
Disease surveillance data show that 1 in 3 Texans with HIV received a late diagnosis of their infection. This is especially true of Latinos-- more than 2 in 5 Latinos with HIV received a late diagnosis. Together this means that many Texans are infected for many years without the knowledge that triggers behavior change, and without the treatment that could lower viral load and reduce transmission. Late diagnosis has also been linked to premature death and higher treatment costs.
In the last five years, the number of Texans reported to be living with HIV has increased by 30% – in 2007, there were about 62,700 people known to be living with HIV. Over this same time period, the annual number of newly reported HIV infections has been stable – about 4,500 cases a year – as has the number of deaths among HIV infected persons (just over 1,000 a year). The Centers for Disease Control and Prevention (CDC) also estimates that the number of new infections is flat across the nation.
So far it appears we are holding the line on new cases of HIV, but better treatment and survival means more and more people are living with the disease. What will it take to drive down new cases?
One of the keys will be increasing early diagnosis of HIV infection. People with HIV must know their status. Knowledge of status has direct and profound impact on the health and well-being of that person, their loved ones, and their community. It also provides an opportunity to halt further transmission. Once people are diagnosed, they tend to take steps to protect their partners. Persons living with HIV are also less likely to infect others if they are on effective treatment that lowers the amount of virus in their systems. So early diagnosis and effective treatment of HIV are important keys to reducing new HIV infections.
In 2006, the Centers for Disease Control and Prevention issued Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Healthcare Settings. These recommendations called for HIV screening for patients' ages 13 to 64 in all healthcare settings. These recommendations are intended to address the persistently high estimates of undiagnosed or late diagnosed HIV infection.
Risk-based testing continues to be important, but new action must be taken to make testing more available.
For many years we have pursued a strategy of risk-based targeted testing (testing based on risk factors). This remains an important commitment, but it is clear that we must take new action to reach those who do not know their status. HIV testing must be more widely available and acceptable.
Stigma remains an important barrier; routine testing may help overcome it.
This illness has been fraught with stigma, and that continues to hamper our efforts today. In order to reach those who will not be touched by risk-based, opt-in strategies, we must normalize HIV testing. The incorporation of routine HIV testing can help us make great strides forward in lessening the stigma that continues to surround HIV.
Routine opt-out testing for HIV must become a part of the medical care encounter.
For many of us, the need for this new strategy has crystallized over the past several years; others have been long-time advocates; and still others remain to be convinced that this should and can be done. We invite you to join us. Learn about routine HIV testing in Texas and help us carry this message of change in our approach to HIV testing.