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The
Centers for Disease Control and Prevention (CDC) have recently described a new
program that places more emphasis on early detection and wide-spread
screening. A recent news report states:
A key ingredient of the new program is access to
rapid HIV tests now being evaluated by the Food and Drug Administration. The
tests, which use a drop of blood or saliva, can produce a result in as little as
15 minutes. Marketing of the tests has been delayed because of doubts about
their reliability, but the CDC is clearly trying to encourage the FDA to make
them available.
Such tests could be used in bars, bathhouses and
other meeting places for people who engage in high-risk behavior. The CDC also
argues that they should be given routinely -- albeit voluntarily -- to anyone who
visits a hospital emergency room or enters jail.
-
Maugh TH. HIV Strains' Resistance to
Drugs on Rise, Los
Angeles Times, Feb. 7, 2001.
The rationale for this policy was published in
The
Lancet for developing countries in 1994 and in
Epidemiology
for the United States in 1995. What follows is an account in The Lancet
(Feb. 24, 2001) of CDC's new
detection strategy.
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In
a major shift in strategy, US health officials say they hope to cut HIV
infection in the USA by half during the next 5 years -- from 40,000 new
infections per year to 20,000 -- by focusing prevention efforts on men and women
who are already infected with the virus. In the past, US prevention strategies
have been directed towards reaching people who were considered to be at high
risk of infection, but who were not yet infected. The new program called SAFE,
for Serostatus Approach to Fighting the HIV Epidemic, will be run by US Centers
for Disease Control and Prevention (CDC).
Somewhere
between 200,000 and 275,000 of the estimated 800,000 and 900,000 Americans
infected with HIV, or roughly one in three, are unaware they carry the virus. 
Unknown HIV infection (August
2001 update)
The AIDS
obstructionists (August 2001 commentary)
The goal of the new program is to make it possible for 30,000 HIV-infected
people to learn that they carry the virus each year. If the program is
successful, by 2005 the percentage of HIV-infected people in the USA who are
aware they are infected will rise from 70% today to 95% and the percentage
receiving appropriate counseling, care, and services will rise from 50% to 80%.
Just
making people aware they are infected should slow the spread of the virus
because most people will take steps, such as adopting safer sex practices, to
reduce the chances that they will spread the infection, says Ronald Valdiserri,
deputy director of the CDC's National Center for HIV, STD, and TB Prevention.
"The majority of people don't want to transmit this virus to anybody
else", he says. Organizers also hope that by putting people on antiviral
treatment and suppressing the virus it may be possible to reduce infectivity and
further curtail spread of the HIV.
As
a major part of the effort, the CDC will work with local public-health
departments and community organizations to make it easier for people to obtain
counseling and be tested, and to make sure people who are found to be infected
have access to appropriate care. By providing services through community
organizations, it is hoped that people who might be uncomfortable in
public-health facilities will find it easier to come in for testing and
counseling, Valdiserri said.
The
programme will also work to improve HIV counseling and testing services being
provided by physicians in private practice. "This is an ongoing
struggle", Valdiserri said. As part of this effort, the CDC for the first
time will target private physicians in particular when it releases its updated
guidelines for HIV counseling and testing this spring.
Michael
McCarthy
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