A Shift in Strategy to Treatment as Prevention for HIV/AIDS

Organizers are calling for big increases in HIV testing and treatment as the 19th International AIDS Conference (IAC) takes place in Washington this week. Testing-and-treating is now central to the U.S. AIDS prevention strategy, and experts say treatment-as-prevention has the potential to dramatically alter the epidemic. In addition to improving a patient's health, treatment can help prevent further transmission of the virus.

Diane Havlir, the U.S. co-chair of the IAC, said, "We can save millions of lives with the knowledge we have today if we fully implement the proven strategies we now have to treat those living with HIV and prevent new infections."

In line with new national guidelines, the District of Columbia announced last month that health care providers will start treatment at once for those newly diagnosed with HIV instead of waiting to see evidence of advanced immune system damage. With free testing offered at a Department of Motor Vehicles branch and more than 20 other locations, the District's HIV screening program is among the most aggressive in the nation.

Since 2006, the District has followed an opt-out HIV screening policy, meaning patients get the test unless they choose not to. Health department surveys of high-risk individuals show that about 70 percent recently diagnosed as HIV-positive had seen a doctor in the previous year but had not been offered the test, said Gregory Pappas, senior deputy director of the department.

In response, D.C. Council member David A. Catania (I-At Large) authored legislation incorporating HIV/AIDS education into requirements for medical professionals' license renewals; the council passed this in May.

The District is the only jurisdiction with a law requiring insurers to cover HIV testing in the emergency room. Doctors say, however, that in practice some insurers may not reimburse physicians if patients show no signs of the disease.

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