Treatment and prevention strategies for HIV infection have advanced enormously in the three decades since the fight against AIDS began. Still, the deadly disease has killed 30 million people worldwide.
AIDS is still incurable, but with antiretroviral drug therapies, HIV-infected people now live long, healthy lives. New therapies can reduce the risk of transmission by an astonishing 96 percent.
Despite medical advances, however, infection rates remain high. Roughly 50,000 new HIV infections occur in the United States each year. Equally troubling, of the nearly 1.2 million Americans who are living with HIV, as many as 25 percent of them don’t know it.
When people don’t know, they can’t manage the disease. Nor can they protect others by preventing HIV transmission.
The nation’s health-care system misses countless opportunities to test people for HIV. Many physicians and emergency rooms simply don’t provide the tests.
A recent survey by the U.S. Centers for Disease Control and Prevention found that nearly three-fourths of gay and bisexual men with undiagnosed HIV had visited a health-care provider in the previous year. Yet nearly half weren’t tested for HIV.
Making sure, through routine testing, that everyone who is infected with HIV knows it would provide an effective and inexpensive way to fight the AIDS epidemic. Such tests should happen automatically when Americans visit their doctors, go to the emergency room, or have other health-care encounters.
Last week, the U.S. Preventive Services Task Force sensibly called for routine HIV screening for all Americans between the ages of 15 and 65. The new guidelines, which are open for public comment through Dec. 17, are similar to a CDC recommendation in 2006.
The guidelines could extend eligibility for HIV screening, without co-pays, as part of free preventive care under the Affordable Care Act. That would remove one of the barriers to testing.
AIDS disproportionately affects poor people and minority groups. African Americans represent 13 percent of the U.S. population, but account for more than half of new HIV infections.
Roughly 25 percent of new infections come from injection drug use; about 40 percent represent men who have sex with men. Another third are men and women infected by heterosexual sex. Women account for 30 percent of new HIV cases, up from 7 percent in 1985.
Low-risk groups are not likely to test positive for HIV. But making HIV screening a routine part of a checkup, similar to a cholesterol test or mammogram, reduces the stigma of testing for all, while vastly increasing the chances that those in higher-risk groups will get screened.
HIV tests are inexpensive. Today’s rapid tests generally cost less than $20, and results are available in as little as 20 minutes.
By contrast, average treatment costs for HIV exceed $25,000 a year, with life expectancy now more than two decades. All of society bears those costs.
Despite medical advances, HIV infection rates won’t drop significantly until practically everyone who has the disease knows it. Routine testing and early treatment ensure the healthiest outcome for those who are infected, while preventing the spread of this costly and still incurable disease.