CDC Outlines New HIV/AIDS Prevention Strategy, Including Opt-Out Testing for Pregnant Women
The CDC today is scheduled to unveil its new HIV/AIDS prevention strategy, which aims to make HIV testing a "routine part of care in doctors' offices and clinics," instead of "waiting for patients to specifically request it," the Los Angeles Times reports. The CDC, which is "advisory but has some authority," will ask states to follow the guidelines in exchange for federal funding. The guidelines include provisions for an opt-out testing program for pregnant women in an effort to reduce mother-to-child HIV transmission. According to the CDC, voluntary HIV testing systems, or opt-in programs, do not "work as well" as opt-out systems that do not "specifically as[k] for consent," the Times reports. The strategy, outlined in the April 18 issue of Morbidity and Mortality Weekly Report, calls for all pregnant women to be tested for HIV, along with a battery of other routine tests already conducted on pregnant women, including tests for syphilis, rubella, group B Strep and hepatitis. If a woman refuses the HIV test, the CDC is suggesting that states test newborn infants for the virus so that they can be treated immediately if necessary. Currently, there are approximately 300 cases of vertical HIV transmission annually, according to CDC statistics, the Times reports. Dr. Andrea Kovacs, director of the Comprehensive Maternal-Child and Adolescent HIV Management and Research Center at the Los Angeles County-USC Medical Center, said, "Right now, what's happening in a lot of places is doctors say, 'You're a nice girl, you're not at risk.' Nobody knows who's at risk. Since this is now a preventable infection for a deadly disease, we really need to do the maximum we can to prevent transmission."
The plan also targets about 200,000 people who are HIV-positive "but do not know it," the Times reports. The CDC is urging local health authorities to "make widespread use" of a rapid HIV test, approved by the FDA in November 2002 (Ornstein, Los Angeles Times, 4/17). In February, President Bush announced that HHS had approved expanded availability for OraSure Technologies' OraQuick HIV test, which offers results that are 99.6% accurate within 20 minutes, to more than 100,000 doctors' offices and public health clinics across the country. The FDA in November 2002 approved the test for use in only about 40,000 hospitals and clinics with laboratories. AIDS groups had advocated for making the test available at smaller outreach clinics and mobile testing sites in order to make the test more accessible to the general population (Kaiser Daily HIV/AIDS Report, 2/12). The CDC wants to offer the test in all federally funded clinics, as well as in places "where people may not have access to routine medical care," such as homeless shelters, jails and substance abuse treatment centers. The agency also wants to simplify the pre-test counseling process -- which doctors have viewed as an "onerous requiremen[t]" -- to encourage doctors to be more proactive in conducting HIV screening and testing, the Times reports. The strategy also calls for a "greater emphasis" on educating HIV-positive people that it "is their responsibility not to infect others." CDC Director Julie Gerberding said that this is a shift in policy because prevention strategies previously had been aimed at changing behavior among HIV-negative individuals, according to the Times. Although states are expected to implement the new guidelines, the CDC is also setting aside $35 million in federal funds for states to "try alternate approaches" for testing and treatment, Gerberding said.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that the new strategy is a "much more aggressive approach toward HIV prevention" and that it is "a long time in coming." He added, "We know from experience that the vast majority of people, when they know they're infected, they become much more careful with their sexual partners. Testing is really the gateway to a realization of a problem." Many AIDS advocates said that more widespread testing efforts need to be accompanied with warnings that positive HIV test results can carry "serious implications," according to the Times. Dana Van Gorder, director of state and local affairs for the San Francisco AIDS Foundation, said, "For a lot of low-income clients in minority populations, the stigma [of HIV/AIDS] is still very real. We're not inventing that." However, Michael Weinstein, president of the AIDS Healthcare Foundation, said that public health has suffered because doctors "have been forced to tiptoe" around HIV/AIDS. He added, "We're reinforcing the stigma of AIDS by saying it has to be treated differently and by saying it has to be hidden" (Los Angeles Times, 4/17). Tom Coburn, co-chair of the Presidential Advisory Council on HIV and AIDS, said, "For too long the CDC's policies have protected the virus rather than the public," adding, "After more than two decades of AIDS, we are finally moving towards addressing the disease as a public health problem. ... This new initiative will work to stop HIV in its tracks by identifying those who are infected earlier and empowering these individuals to protect their own health and to prevent passing the virus onto others" (Coburn release, 4/16).