TARGETING THOSE ALREADY INFECTED WITH HIV 


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Last Updated

28 Dec 2002

 

McCarthy, M. New US HIV-prevention program to target those already infected

The Lancet 357(9256), Feb. 24, 2001. 

Frerichs reflection:

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.  

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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