In the past decade, significant advances have been made in the treatment of individuals with human immunodeficiency virus (HIV) infection. When successfully implemented, today's HIV care practices can slow the clinical progression of the disease, improve the quality of life of persons living with HIV, and reduce HIV-related mortality. Under the traditional model of risk-based HIV testing (testing only those patients who report practicing HIV risk behaviors), many HIV-infected individuals are not diagnosed with HIV until they have advanced HIV infection or acquired immune deficiency syndrome (AIDS).1-3
For example, 45% of all patients diagnosed with AIDS between 2000 and 2003 were first diagnosed with HIV less than 1 year prior to being diagnosed with AIDS, an advanced stage of immunosuppression during which opportunistic infections often occur.3
Thus, for many HIV-infected persons, access to clinical HIV care and timely information on preventing HIV transmission are significantly delayed because they are unaware of their HIV status.
At present, approximately 250,000 people in the United States are living with an undiagnosed HIV infection.4
These individuals are at risk for complications of untreated HIV, and of unknowingly transmitting the virus to others. The Centers for Disease Control and Prevention (CDC) estimates that more than half of the approximately 32,000 new sexually-transmitted HIV infections that occur each year result from the sexual activities of persons with HIV who are unaware of their serostatus.5
Many HIV-positive persons, once aware of their HIV infection, decrease high-risk sexual behaviors with HIV-negative partners.6-7
Thus, diagnosing prevalent HIV infections is an essential tool for reducing new transmissions.
The availability of reliable, inexpensive, and noninvasive HIV antibody tests and effective HIV therapy has led many public health leaders to advocate for the expansion of routine, voluntary HIV screening.8-9
Screening involves performing a test for HIV antibodies on either blood or oral fluid in asymptomatic patients. Rapid tests are available that can provide results in about 20 minutes in appropriate settings. Those patients who are positive must undergo confirmatory testing with a Western Blot test.
In 2006, the CDC issued revised HIV testing recommendations to encourage the adoption of universal screening for patients age 13−64 years, without regard to risk behavior, and in all medical settings. These guidelines recommend changes regarding who should be tested for HIV, the consent process for HIV testing, and whether HIV prevention counseling should accompany all HIV testing.
Here we provide a synopsis of the CDC's recommendations and the rationale underlying the specific protocol advanced by the CDC. We then discuss current Wisconsin law regarding HIV testing, challenges associated with reconciling state law with current CDC guidelines, and ethical concerns surrounding the guidelines.