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Los Angeles Times Examines Recommendations for HIV Testing as Part of Routine Medical Care

December 8, 2008

The Los Angeles Times on Monday examined new practice guidelines issued recently by the American College of Physicians recommending routine HIV testing for all patients beginning at age 13, regardless of whether they engage in high-risk behaviors. CDC in 2006 also released recommendations for HIV screening as part of routine medical care.

Bernard Branson of the HIV/AIDS prevention division at CDC, who helped develop the agency's current recommendations, said that although physicians in the past might have limited HIV screening suggestions to high-risk patient groups, this approach often failed to identify new HIV cases. By recommending routine HIV screening for all patients, physicians can avoid asking patients sensitive questions about sexual activity and high-risk behavior. In addition, universal HIV testing can benefit teenage patients, who may be reluctant to discuss their sexual activity if they are accompanied by parents, Branson said. He added that patients can benefit from early HIV diagnosis because early treatment is more effective and can delay progression to AIDS. In addition, HIV/AIDS researchers say that increased awareness can slow the spread of HIV, because people who are aware of their HIV-positive status might engage in fewer risky behaviors.

According to the Times, obstacles to universal HIV screening are "falling away" as some states are requiring health insurers to cover HIV testing costs and fewer states are requiring counseling and informed consent before conducting blood tests. However, some physicians still might hesitate to suggest HIV screening because it could "open up a discussion that the physician feels he or she doesn't want to get into or doesn't have time for or doesn't have training for," Thomas Coates, director of the global health program at the University of California-Los Angeles David Geffen School of Medicine, said. He added that recommending universal HIV screening also raises questions about counseling, referrals and partner notification if the patient tests HIV-positive. However, Coates said it is important to recommend HIV screening even without follow-up discussions because it indicates to patients that HIV tests are an important component of medical care. This can convey important health messages to teenagers, Coates said, adding that when a physician recommends HIV testing, "it's kind of a signal to the adolescent that this is something that he or she needs to think about." Christina Elston, managing editor at L.A. Parent magazine, said HIV screening is "a health issue. It isn't a sex issue," adding that sometimes "parents confuse that" (Adams, Los Angeles Times, 12/8).

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