ORLANDO, Fla. – Tests for HIV should be part of routine checkups for all Americans between the ages of 13 and 64, federal health officials recommended Thursday.

Previously, only those considered to be at “high risk” for the deadly virus – intravenous drug users and homosexuals, in particular – were routinely tested.

By making HIV screening as normal as checking cholesterol levels, the Centers for Disease Control & Prevention hopes to remove the stigma attached to the tests. It also would enable doctors to detect more cases early and slow the spread of the virus, said Dr. Timothy Mastro of the CDC.

“It irritates me that, especially in the Latino community, people feel that if they take the HIV test it labels them as gay or as a prostitute. This recommendation would remove that stigma and help reduce the number of HIV cases,” said Rudy Chacin, coordinator of Cafe Latino, a coalition of HIV/AIDS and other health-related groups.

More frequent testing would be recommended only for those at high risk.

Patients would be able to decline the tests and physicians would not be legally bound to administer them. Still, the recommendations are expected to influence doctors and health insurance coverage.

“I think that the new guidelines make sense because, unfortunately, HIV is still on the rise in the general population and we don’t always know who is at risk,” said Lisa Kaston at the Hope and Help Center of Central Florida, a Winter Park AIDS service group.

It is estimated that 250,000 Americans have HIV but are not aware of it. The virus infects 40,000 people each year, according to the CDC.

Nearly half of new HIV infections are discovered when doctors examine patients who do not know what is causing their illness, CDC officials said.

AIDS is still the leading cause of death among 24-44 year old African Americans in the United States, noted Bill Toth, epidemiologist for the Orange County, Fla., Health Department.

But whether or not physicians will actually implement the new guidelines “is a good question,” Toth said.

“This will be pushed pretty hard in the general practice community,” he said. “But access to care is a tough piece of this.”

CDC officials estimated that the HIV tests might add as much as $80 to a checkup, depending on the outcome and the test used. It is expected that private insurance companies and federal health care programs will pay for the tests once the new guidelines are implemented.

“For every case that is picked up early, I can’t begin to imagine how many dollars you save by stopping or slowing the transmission of the virus to others,” Toth noted.

Barbara Blair, a retired nurse and volunteer for the AIDS Care Team of Volusia and Flagler County, Fla., supports making HIV tests part of routine medical exams but she wondered how insurance companies will respond.

“My only question is what the insurance companies will do if they find out you are positive – that may be a big factor,” she said.

Under the new guidelines, patients would be tested for HIV as part of a standard battery of tests they receive when they go for urgent or emergency care, or even during a routine physical.

But the president of the American Academy of Family Physicians questioned whether there was enough evidence to expand testing beyond high-risk groups. He also expressed doubts about whether most doctors would make HIV tests part of their routine exams.

The CDC recommendations were endorsed by the American Medical Association, which urged doctors to comply.


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