Fighting HIV, a Community at a Time

A study planned for the District of Columbia and the Bronx in New York City will determine the feasibility of offering nearly every adult in the community routine HIV testing, as well as prompt treatment for those infected.

The National Institute of Allergy and Infectious Diseases (NIAID) is paying to study the "test and treat" strategy to see whether barriers to diagnosis and medical care can be surmounted. CDC recommends universal, voluntary HIV testing of people ages 13-64 as part of routine medical care in doctors' offices, clinics, and emergency departments.

In both communities, researchers have been meeting with hospital and health officials to discuss the adoption of CDC's recommendation. Testing may also be offered in non-medical settings, said Dr. Anthony S. Fauci, NIAID's director.

In the District, one-third to one-half of those with HIV have not been diagnosed. Further, of people who tested positive in 2006, only 50 percent sought a doctor's care for HIV within six months.

Someone who tests positive in the field "can walk off that day and decide, 'I'm going to pretend that never happened,'" said Angela Fulwood Wood, deputy director of Family and Medical Counseling Service, which does mobile HIV rapid testing in the District. "There are so many people who test 'preliminary reactive' who never return," said Torena White, head of an FMCS outreach team. Training for community workers, therefore, emphasizes getting those infected into treatment.

The Bronx has the highest AIDS mortality rate of any New York City borough, though Manhattan has a higher rate of cases. In the first half of 2008, "more than a quarter of the people who were tested in the Bronx had AIDS by the time they received their [first HIV-related] diagnosis," said Dr. Monica Sweeney, the city's assistant health commissioner for HIV prevention and control.

"Routine testing at either emergency rooms or physicians' offices -- I think that's our biggest chance of really catching people earlier," especially those who do not perceive they are at risk of infection, said Wood.

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