CDC will unveil a new HIV testing strategy Thursday designed to expand screening among pregnant women and about 200,000 others who are infected but do not know it. The new strategy specifically urges the testing of all pregnant women rather than relying upon patients to volunteer for testing. The guidelines also make HIV testing a routine part of care in doctors' offices and clinics, rather than waiting for patients to specifically request it. The strategy, outlined Thursday in CDC's Morbidity and Mortality Weekly Report, is advisory but has some authority: CDC will ask state and local governments to adhere to it in exchange for federal funding.

The guidelines stem from the realization that existing HIV prevention programs "have really stalled recently," said CDC Director Dr. Julie L. Gerberding. "Where we are right now is pretty intolerable," she said. With the number of new HIV cases hovering around 40,000 annually for the past decade, Gerberding and many other public health officials say it is time for physicians to screen for HIV just as they do for diabetes or hypertension. To encourage such testing, CDC wants to streamline the pre-test counseling process. The agency will also allocate $35 million in new funds to allow states to try alternative approaches that get patients diagnosed and into treatment, she said.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the guidelines represent a "much more aggressive approach toward HIV prevention" nationally, which he said is "a long time in coming." "We know from experience that the vast majority of people, when they know they're infected, they become much more careful with their sexual partners," said Fauci. "Testing is really the gateway to a realization of a problem."

However, some AIDS prevention groups say the testing push needs to be tempered by the reality that positive tests carry serious implications. "For a lot of low-income clients in minority populations, the stigma is still very real," said Dana Van Gorder, a San Francisco AIDS Foundation official. In addition, Charles Henry, a Los Angeles County AIDS official, said "You have to make sure that you have primary care available" afterward. "We have a huge uninsured and underinsured population."

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