The Centers for Disease Control and Prevention recommended routine “opt-out” HIV screening tests for health care settings in 2006. This means you automatically get an HIV test offered in most places you go for health care, but you can choose to opt out, or reject the test. There is a similar recommendation for jails. Health care providers have been slow to implement this recommendation. Recent articles in the medical literature discuss testing in various settings.
HIV-infected patients are at increased risk for cancer. Thus, authors at the Department of Veterans Affairs suggest that oncologists should routinely offer HIV screening for their patients. Those who test positive may expect better clinical outcomes with appropriate treatment for both conditions.
Emergency departments have made more progress in HIV screening. In a recent study, 28,042 patients were eligible for testing. Of these, 6,933 (25 percent) completed the testing, and 15 new infections were diagnosed.
Jails present an efficient location for HIV screening, since approximately 10 million Americans per year enter jails, usually for a a short time while awaiting trial. Two recent studies, one for a men's jail and the other for a women's jail, examined the optimum time to offer HIV tests. Inmates were divided into three groups, and offered a free test at one of the following times: (1) same day the person entered jail, (2) the next day, or (3) seven days after entry. Both men and women were most likely to accept testing when it was offered the day after entry into jail. Testing rates were higher for women. The percentages of inmates choosing to be tested in each group were as follows:
1. Men, Day 1: 45 percent
2. Men, Day 2: 53 percent
3. Men, Day 7: 33 percent
4. Women, Day 1: 55 percent
5. Women, Day 2: 73 percent
6. Women, Day 7: 50 percent
I hope someday HIV can be eradicated, as smallpox has been. Until then, the optimum way to find and treat infected individuals will be a subject of research and debate.
1. Chiao EY et al, “Time for oncologists to opt in for routine opt-out HIV testing?” JAMA 2010 Jul 21; 304(3): 348-9.