HIV testing should be routine part of primary health care for sexually active

om 1999 to 2002 were acquired heterosexually. Since the early 1980s, the proportion of people acquiring HIV infection through heterosexual transmission has continued to increase relative to other methods of transmission. Approximately 250,000 people in the United States infected with HIV do not know they are infected, according to the Foundation for Retrovirology and Human Health.

"Based on an extensive review of the current state of HIV infection, we believe an immediate change to routine voluntary testing is a necessary and critical step to reduce HIV infection and prevent AIDS in this country," says Carlos del Rio, professor of medicine at Emory University School of Medicine, chief of medical services at Atlanta's Grady Memorial Hospital and one of the study authors. "We are missing opportunities to diagnose HIV infection before individuals develop AIDS, when we can offer counseling about secondary prevention and risky behaviors, begin antiretroviral therapy and help prevent opportunistic infections."

Current recommendations for testing in high-prevalence areas (where HIV infection is greater than one percent) and testing based on risk assessment are impractical and inaccurate, the research team reports. Most health care providers do not have access to estimates about prevalence in their particular area, and often it is difficult to determine the risk of HIV infection in individual patients. Smaller social networks with a high prevalence of infection also can be part of a larger community where prevalence is low, making accurate risk assessment more difficult.

"Many people who engage in risky behaviors are reluctant to tell their healthcare providers and may not request HIV testing," says del Rio. "People infected through heterosexual transmission, particularly adolescents, often do not consider themselves to be at risk and do not seek testing on their own. Health care providers also may not elicit accurate information about risk. Routine

Contact: Holly Korschun
Emory University Health Sciences Center

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