U.S. public health officials are instituting new measures to reduce the country's relatively small, but persistent HIV epidemic.
About 900,000 people are infected with HIV in the United States, and the government's Centers for Disease Control, the CDC, estimates that one-fourth of them do not know it. They might be contributing to the 40,000 new national HIV cases that appear each year.
Those numbers are small compared to the hardest hit regions of Africa and Asia, but CDC director Julie Gerberding said they will not get smaller if large numbers of infected people continue to be unaware of their status.
"We are not achieving the progress that we intended to achieve with overall HIV prevention programs," Dr. Gerberding said.
To remedy the problem, the Centers for Disease Control has initiated new HIV control measures that the agency hopes will reach more infected people. These measures are intended as guidance to health care workers throughout the United States
The recommendations include making HIV testing a routine part of medical care, including the standard battery of pregnancy tests. The agency recommends widespread use of a recently-approved rapid HIV test that can determine infection status in 20 minutes.
"Doctors need to be able to contribute to the identification and diagnosis of HIV and we all want people who are infected to benefit from the life-saving therapies that we have," Julie Gerberding said.
Dr. Gerberding points out, however, that her government agency is not recommending mandatory HIV testing. People visiting doctors will be able to refuse.
The new program will also recommend that in doctor's offices, HIV counseling be reduced or eliminated. The CDC director says that counseling is a proven method of influencing people to avoid risky sexual activities. But she notes that U.S. physicians usually do not have enough time to counsel patients and take a blood test, too. In this situation, the test is more important.
Dr. Gerberding says the program will also expand prevention efforts by focusing not just on the risky behaviors of uninfected people but also on the infected and their partners.
"We haven't put as much emphasis on HIV infected people as perhaps we should," said Dr. Gerberding. "When a person with HIV infection is diagnosed, it's very important to know who their partners are and to make sure that the partners have access to testing and the same treatment services if they're infected and the same prevention management services."
Dr. Gerberding said the new U.S. public health initiative does not replace any HIV prevention programs it already has, but adds to them in an effort to reduce the country's persistent caseload.