In contrast to my rejection of (or questioning the real evidence in favor of) routine cancer screening practices in U.S. health care, I embrace the new HIV screening guidelines (due out later this month) from the U.S. Preventive Services Task Force (USPSTF). Their previous HIV screening guidelines, issued in 2005, only recommended HIV screening for adolescents and adults deemed to be at increased risk for HIV infection. The about-to-be released updated guidelines recommend that clinicians routinely screen all adolescents and adults ages 15-65 years and all pregnant women for HIV infection (as well as younger and older patients who are at risk for HIV infection).
They base their new recommendations on compelling evidence that earlier identification and treatment of HIV infection (before a person begins to have symptoms of disease) improves clinical outcomes for the individual, as well as significantly reduces the chance of transmission of HIV to other people. “The USPSTF concludes with high certainty that early detection and treatment of HIV transmission would result in substantial public health benefits in the United States.”
Since 2006, the CDC has recommended routine voluntary ‘opt-out’ HIV testing of adolescents and adults in the U.S. (opt-out meaning all patients be informed of routine testing and tested unless they decline). The CDC also recommended eliminating the pre-test counseling and the signed patient consent requirement for HIV testing, pointing out (correctly in my experience) that these act as barriers to HIV screening. The USPSTF clinical guidelines carry more weight with the passage of the 2010 Affordable Care Act that has a provision requiring all health insurers to cover all preventive services endorsed by these federal guidelines.
So today, on World AIDS Day, let’s remember the estimated 30 million people worldwide who have died of AIDS and the 60,000 people in the U.S. who have died of AIDS since the beginning of the epidemic. Let’s remember that HIV/AIDS continues to disproportionately affect people living in African countries, as well as African-American, Hispanic people and people living in the ‘Black Belt’ of Southern poverty in the U.S. because of social determinants of health. Let’s stop thinking of HIV/AIDS as something shameful/stigmatizing and a death sentence. Let’s “Work together for an AIDS-free generation.” Know your HIV status and encourage others to know theirs. This is a case in which we can steal the Komen Foundation‘s slogan “Early detection saves lives” and be telling the truth.
For a unique health-related holiday gift for yourself or for your loved ones (tongue and cheek), you can order the newly-FDA approved home rapid HIV test (Oraquick/uses a swab of fluid at gum line/takes 20-40mins) directly from Oraquick. It is delivered to your doorstep in an ‘unmarked brown box.’ You can also buy it (assuming you are at least 17 years old) from your local pharmacy. List price is $39.99 (exact same test only costs ~$17 in clinics/manufacturer says the increased price goes to pay for their 24/7 information hotline with bilingual English/Spanish representatives). In contrast, I’ve read estimates of the more sensitive HIV ‘blood tests’ available in clinics as costing on average $1.50).
Additional resources: Check out the AIDS.gov website, and especially their link to CDC testing/treatment/supportive services (like mental health and substance abuse counseling, and housing). It has some cool downloadable apps for searching for HIV/AIDS related services in your area. If you don’t need to use it for yourself or your family, you can use it for patients you might work with. I’m glad to know I have 34 HIV testing sites within a 10 mile radius of my home.