Eight years after the U.S. Preventive Services Task Force rejected the idea of routine HIV-testing for U.S. adults and adolescents, it is poised to reverse that decision, recommending in favor of universal HIV screening. In a new thought-provoking “Perspective” in the New England Journal of Medicine, Sociomedical Sciences Professor Ronald Bayer, PhD, and co-author Gerald Oppenheimer, PhD, write about the end of 25 years of debate on the benefits of widespread HIV screening.
The change of heart is largely based on new evidence that early antiretroviral treatment not only significantly lowers the burden of HIV/AIDS in those who are infected, but it is also an effective means of reducing the transmission of HIV. With the new recommendation, they write, "the curtain will at last come down" on the longstanding debate over whether screening should be aimed at targeted groups or be a routine element of clinical practice.
Major points by Drs. Bayer and Oppenheimer include:
- More than 1 million Americans are living with the infection of whom 20-25% are unaware of their HIV status because of the absence of routine testing. There are 56,000 new infections every year, many of which would not be identified for years, for the same reason.
- Consequently, thousands of people lost a critical opportunity to start antiretroviral therapy early. This not only resulted in their own loss of well-being but also posed a public health hazard and source of ongoing transmission.
- The latest U.S. Preventive Services Task Force report has important policy implications since the Affordable Care Act mandates that all public and private health plans provide coverage for USPSTF-recommended preventive services without patient co-payments.