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* Department of Medicine and Community Health, Warren Alpert Medical School, Brown University, Providence, RI; also The Fenway Institute, Fenway Community Health, Boston, MA, USA
Correspondence to: Dr Kenneth Mayer Email: Kenneth_Mayer{at}brown.edu
In November 2006, the United States Centers for Disease Control and Prevention updated their recommendations for HIV-testing in health-care settings in the USA. The new guidelines recommended routine HIV-testing not based on patient risk, opt-out testing, no separate consent for HIV-testing and no requirement for pretest counselling. Three cardinal points underlie the changes: risk-based testing has not identified all HIV-infected individuals in the USA, opportunities for diagnosis and management of HIV are being missed and routine HIV screening is cost-effective. Routine screening for HIV is desirable and should be achievable, but challenges still remain in introducing it in the USA. State-by-State changes in laws have had to be made, the impact on providers and payers must be considered and proactive screening programmes must be supported by faith and cultural leaders in the highly affected communities. Furthermore, non-specialist clinicians must be trained to deal with all aspects of HIV-testing in an appropriate and professional manner. Despite fears that the public would not accept the new approach, many Americans believe that HIV-testing is an appropriate part of a medical check-up. With the public's support, newly diagnosed HIV-infected individuals will benefit from treatment, and society will benefit because of reduced HIV transmission.
Key Words: advanced HIV disease • AIDS, counselling • HIV-testing, informed consent • late diagnosis • opt-out policy • recommendations • risk assessment • routine • screening
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