Human Immunodeficiency Virus and the New CDC Guidelines

Since the Human Immunodeficiency Virus (HIV) was first recognized in the United States in the early 1980’s, science and medicine have made significant progress managing HIV. However, this progress may have left many youth with little personal knowledge or experience of the devastating effects of the disease. In Missouri, an estimated 10,000 individuals are living with HIV/AIDS and every year approximately another 500 individuals will be diagnosed.2 Teens and young adults are among those at greatest risk for HIV infection in Missouri, along with individuals of color, including African-Americans and Latinos. According to the Centers for Disease Control and Prevention (CDC), youth aged 13-24 represented 13 percent of all diagnoses in 2004. A more surprising finding to some is that young women in heterosexual relationships are among those at greatest risk.1 In October 2006, the CDC published new guidelines recommending that HIV screening be included during routine medical care. The CDC now recommends expanding HIV testing to become routine for all adolescent patients 13 years of age or older. Previously, the guidelines encouraged screening only those who were considered high risk for HIV, and required consent to an HIV test, as well as pre- and post-test counseling. Although the CDC still recommends prevention counseling, especially for those who are considered high risk, it no longer requires counseling as part of the screening procedure. Consent recommendations have also changed. Testing should never be completed without the patient’s knowledge, but the new guidelines give the patient an opt-out choice. In opt-out testing, a patient must specifically decline to be tested for HIV after being notified either verbally or in writing that an HIV test is to be done. In Missouri, physicians are required to consult with patients prior to the HIV test, but state law does not require written consent (Missouri Statute 191.653 and Regulation 19 CSR 20-26.040). The Missouri Department of Health and Senior Services’ Bureau of HIV/STD and Hepatitis supports opt-out testing. Repeat screening should take place for those 13-64 years old based on clinical judgment. Those who fall into standard high-risk groups should be screened annually. These groups include: men who have sex with men; IV drug users; individuals who engage in sex for drugs or money; sex partners of HIV-infected individuals; and heterosexuals who have had more than one sex partner or whose sex partner has had more than one sex partner since the most recent HIV test. Finally, HIV test results should be provided to the patient in the same confidential manner as all other routine test results. The CDC recommends that in order to reduce the number of undiagnosed HIV cases, HIV screening needs to be integrated into routine medical care.