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HIV Testing

October 27, 2009

At the end of 2006, an estimated 1,106,400 persons (range: 1,056,400 - 1,156,400) in the United States were living with HIV. CDC estimates that 56,300 new HIV infections occurred in the United States in 2006.1

Each year, approximately 16-22 million persons in the United States are tested for HIV. By 2002, an estimated 38%-44% of all adults had been tested for HIV.3 However, at the end 2006, approximately 1 in 5 (21%, or 232,700 persons) did not know they were infected.4

HIV testing is entering a new era in this country as lawmakers, health care and insurance executives, and public health officials are making changes in their respective fields to ensure that more people will know their HIV status -- an important consideration for maintaining health and reducing the spread of the virus.

In September 2006, CDC released Revised Recommendations for
HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings
. These new Recommendations, which replace CDC's 1993 Recommendations for HIV Testing Services for Inpatients and Outpatients in Acute-Care Hospital Settings, advise routine HIV screening of adults, adolescents, and pregnant women in health care settings in the United States. They also recommend reducing barriers to HIV testing. See CDC Response for more information on the revised testing recommendations.


Rationale for Routine Screening for HIV Infection

People who are infected with HIV but not aware of it are not able to take advantage of the therapies that can keep them healthy and extend their lives, nor do they have the knowledge to protect their sex or drug-use partners from becoming infected. Knowing whether one is positive or negative for HIV confers great benefits in healthy decision making.

Cohort studies have demonstrated that many infected persons decrease behaviors that help transmit infection to sex or needle-sharing partners once they are aware of their positive HIV status.5-12 HIV-infected persons who are unaware of their infection do not reduce risk behaviors.13,14,15 Persons tested for HIV who do not return for test results might even increase their risk for transmitting HIV to partners.16 Because medical treatment that lowers HIV viral load might also reduce risk for transmission to others,17 early referral to medical care could prevent HIV transmission in communities while reducing a person's risk for HIV-related illness and death.


References

  1. Hall HI, Ruiguang S, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300:520-529.
  2. Glynn M, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003. National HIV Prevention Conference; June 2005; Atlanta. Abstract T1-B1101.
  3. CDC. Guidelines for national human immunodeficiency virus case surveillance, including monitoring for human immunodeficiency virus infection and acquired immunodeficiency syndrome. MMWR 1999;48(RR-13):1–28.
  4. CDC. HIV Prevalence Estimates -- United States, 2006. MMWR 2008;57(39);1073-1076.
  5. Rietmeijer CA , Kane MS, Simons PZ, et al. Increasing the use of bleach and condoms among injecting drug users in Denver: outcomes of a targeted, community-level HIV prevention program. AIDS 1996;10:291–8.
  6. Rhodes F, Malotte CK. HIV risk interventions for active drug users. In: S.Oskamp, S.Thompson, eds. Understanding HIV risk behavior: safer sex and drug use. Thousand Oaks, CA: Sage Publications, 1996:297–36.
  7. Gibson DR, Lovelle-Drache J, Young M, Hudes ES, Sorensen JL. Effectiveness of brief counseling in reducing HIV risk behavior in injecting drug users: final results of randomized trials of counseling with and without HIV testing. AIDS and Behavior 1999;3:3–12.
  8. Doll LS, O'Malley PM, Pershing AL, Darrow WW, Hessol NA, Lifson AR. High-risk sexual behavior and knowledge of HIV antibody status in the San Francisco City Clinic Cohort. Health Psychol 1990;9:253–65.
  9. Cleary PD, Van Devanter N, Rogers TF, et al. Behavior changes after notification of HIV infection. Am J Pub Health 1991;81:1586–90.
  10. Fox R, Odaka NJ, Brookmeyer R, Polk BF. Effect of HIV antibody disclosure on subsequent sexual activity in homosexual men. AIDS 1987;1:241–6.
  11. van Griensven GJP, de Vroome EMM, Tielman RAP, et al. Effect of human immunodeficiency virus (HIV) antibody knowledge on high-risk sexual behavior with steady and nonsteady sexual partners among homosexual men. Am J Epidemiol 1989;129:596–603.
  12. Coates TJ, Morin SF, McKusick L. Behavioral consequences of AIDS antibody testing among gay men [Letter]. JAMA 1987;258:1889.
  13. Wenger NS, Kusseling FS, Beck K, Shapiro MF. Sexual behavior of individuals infected with the human immunodeficiency virus: the need for intervention. Arch Intern Med 1994;154:1849–54.
  14. Desenclos J-C, Papaevangelou G, Ancelle-Park R, for the European Community Study Group on HIV in Injecting Drug Users. Knowledge of HIV serostatus and preventive behaviour among European injecting drug users. AIDS 1993;7:1371–7.
  15. Dawson J, Fitzpatrick R, McLean J, Hart G, Boulton M. The HIV test and sexual behavior in a sample of homosexually active men. Soc Sci Med 1991;32:683–8.
  16. Otten MW Jr, Zaidi AA, Wroten JE, Witte J, Peterman TA. Changes in sexually transmitted disease rates after HIV testing and posttest counseling, Miami, 1988 to 1989. Am J Pub Health 1993;83:529–33.
  17. Quinn TC, Wawer MJ, Sewankambo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. N Eng J Med 2000;342:921–9.




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