By Steve Sternberg
A major government push to make HIV testing part of every doctor's medical routine has only modestly increased the number of people tested, federal officials reported Tuesday.
An estimated 45% of people between the ages of 18 and 64 reported last year that they've had an HIV test, up 11 million or 5% since 2006.
That brings the number of people tested so far to 83 million, according to a report by the Centers for Disease Control and Prevention.
But vast gaps remain, the study showed. More than half of all adults have never been tested, and an estimated 200,000 people or more are HIV positive but don't know it.
CDC Director Thomas Frieden called the increase over three years "reasonable," but he says the job is far from done.
"It's encouraging, but it's not success," Frieden says. "It's very far from success."
The analysis marks the CDC's first comprehensive effort to measure the impact of the agency's 2006 recommendation to make HIV testing as routine as tests for high cholesterol or diabetes. The CDC also urged annual testing of people in high-risk groups, including gay and bisexual men and people who have abused intravenous drugs or traded sex for drugs.
The CDC estimates about 1.1 million Americans have HIV, and about 20% don't know it. About 56,000 new infections occur each year in the USA.
More than 25% of people in high-risk groups have never been tested for HIV, and nearly one in three people who are infected with the AIDS virus aren't diagnosed until years after infection when it's too late to reap the benefit of early treatment.
David Paltiel, a researcher at Yale Medical School who was not involved in the study, described the report as a "rather painful assessment of just how little progress we've made in detecting HIV in the U.S."
Michael Saag, an AIDS expert at the University of Alabama, Birmingham, says "an increase of 5% is certainly an increase, but it's a pretty meager success."
Studies show that people who know they're positive for HIV are nearly four times less likely to infect others, says Bernard Branson of the CDC. Treatment doubles as a means of prevention, by making those who carry the virus less infectious, Branson says.
Preventing infections also saves money — about $367,000 in lifetime medical costs per patient, the CDC reports. A separate study found that patients with HIV who were diagnosed early in the course of their disease cost $27,000 to $61,000 less to treat than those diagnosed once the disease was more advanced, Branson says.
Several researchers said the government has not yet begun to seriously grapple with the cumulative cost of the 2006 testing policy, which Paltiel's team pegs at $2.7 billion. About 82% of those costs are related to increased treatment costs for those who test positive for HIV, many of whom don't have insurance.
"Think about black males in this country who experience the greatest prevalence of infection in the USA," says Cornelius Baker of the AED Center for AIDS and Community Health. "There's about 30% unemployment in many communities that don't have an adequate health care system. People don't get routine care. That's what makes health reform so important."
Branson says big savings will come from preventing tens of thousands of cases over time.
Saag says testing is still the best way to prevent infections. The 20% "of people who are infected and don't know it are responsible for up to 60% of new infections" he says. "I feel pretty strongly about finding people who are infected and getting them tested."
source: http://www.usatoday.com/yourlife/sex-relationships/2010-11-30-aids-testing_N.htm
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