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Leveling off of HIV tests causes debate

By Tom Randall
Detroit Free Press

NEW YORK — AIDS testing leveled off in the United States from 2001 to 2006 after a decade of expanded screening, prompting scientists to call for new ways to encourage more Americans to get checked, a new report said this week.

About 10% of Americans said they were tested for HIV, the virus that causes AIDS, in 2006, the most recent year covered in the study, and about 40% reported having a test at some point in life, according to a report published Thursday by the Centers for Disease Control and Prevention.

The CDC has been pressing for all adults up to age 65 to be screened in order to diagnose as many as 250,000 people who may be infected with HIV without knowing it. The Atlanta-based agency in 2006 began urging emergency rooms and primary-care doctors to offer testing to their patients, regardless of their risk for the disease.

“This study showed that through strategies that only targeted people who were especially at risk, the total number of people getting tested remained flat,” said Bernard Branson, associate director for laboratory diagnostics in CDC’s division of HIV/AIDS prevention, which conducted the study. “These data substantiate the need for the new approach.”

A study released last year supported the opposite approach of targeted testing. Focusing the additional effort on higher-risk people would diagnose three times as many patients and might quadruple the number of new cases of HIV prevented, said David Holtgrave, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore. His study was published in June 2007 in the online journal Public Library of Science Medicine.

HIV estimates off
HIV is spreading about 40% faster in the United States than federal health officials previously estimated, the CDC reported this week. About 56,300 Americans contract HIV annually, compared with past CDC estimates of 40,000 infections a year.

Studies show that people who know they have HIV are more likely to avoid spreading it, though researchers disagree about the best way to find unknowing carriers of the disease. CDC scientists began recommending universal HIV testing in September 2006 to reduce the number of Americans who have the human immunodeficiency virus, don’t know it and risk spreading it.

Thursday’s study will be used as a baseline to be compared with future surveys, to monitor the effect of the agency’s new recommendations, Branson said.

More than 1 million Americans have HIV -- about 1 in 300. About 33 million people worldwide are infected with the virus and 2.7 million new cases were reported in 2007, according to UNAIDS, the New York-based agency that coordinates the United Nations’ response to the disease.

The percentage of U.S. residents tested for HIV increased to 38% in 1997 from 6% in 1987. The rate remained about 40% from 2001 to 2006, the years studied in Thursday’s report. The number of people who reported taking the test in the preceding year fell to about 10% a year in 2001-2006 from a peak of 15% in 1997.

The CDC has recommended that all U.S. adults be offered so-called opt-out HIV screenings, in which they would be tested unless they refused. While most states require counseling before an HIV screening, the CDC recommends that counseling be given to patients only after they have been diagnosed with the virus.

The agency’s report was issued while researchers, advocates and officials participate in the 17th International AIDS Conference in Mexico City.

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