The CDC Recommends Universal HIV Testing for Everyone

The CDC's HIV Testing Recommendations

Nurse doing blood test
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Have you noticed something different lately at your doctors' visits? Maybe not, but you definitely should have. Starting in September 2006, the CDC began recommending that doctors routinely test every patient for HIV, regardless of their risk, when they come in for a health care visit.

This was a change of policy for the CDC. Up until relatively shortly before the new guidelines were implemented, HIV testing was recommended primarily for people at high risk of disease, and extensive pre-test and post-test counseling was required to be included as part of standard procedure.

The problem was that this didn't work. Testing only high-risk people misses many, if not the majority of, early HIV infections. It also needlessly increases the risk of infants being born with HIV since treatment during pregnancy is extremely effective at reducing transmission.

The new type of testing is known as "opt-out testing." In this form of testing, the test is given unless patients specifically refuse it. In general, opt-out testing has been found to be an effective way of increasing the number of people screened for disease when compared to opt-in procedures where individuals must request testing. People will still be asked if they want to be tested for HIV, but testing will no longer require separate written consent or counseling and will be presented as part of routine care.

As a result, although HIV testing will still be voluntary, far more people will end up undergoing testing.

However, because this is a recommendation, and not a law, not all U.S. states are following the new guidelines.

Who Should Be Offered Routine Testing?

  • All pregnant women. Testing should take place as early as possible during pregnancy and then again during the third trimester. Rapid testing during labor is recommended for pregnant women with no HIV test on record.
  • All patients between the ages of 13 and 64 at their regular health care visit, unless fewer than 1 in 1,000 patients in the population served by the care site have tested positive for HIV.
  • All patients seeking sexually transmitted disease (STD) treatment or care at an STD clinic.
  • All patients who have been diagnosed with TB (tuberculosis).

Who Should Seek Out Additional Testing?

  • People at high risk of HIV - including injection drug users and their sexual partners, people who exchange sex for money and their sexual partners, and individuals who have had more than one sexual partner since their last HIV test - should be tested at least once a year.
  • Everyone should receive an HIV test before beginning a sexual relationship with a new partner.

Unfortunately, there are still a lot of people who are not getting tested for HIV, even under the new recommendations. That's potentially a big problem for both individual and public health, which is why in 2015 -- 9 years after the original recommendation for universal testing -- the CDC set up a new program to really push primary care doctors towards making testing part of standard care.

Recommendations alone, sadly, just weren't enough.

Branson, et al. " Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings." 2006. MMWR: 55(RR14):1-17

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