Our current medical systems have supported the concept of HIV/AIDS as an “exceptional” disease, one which requires special considerations even before people can receive an HIV test. This exceptionalism, in turn, tends to breed stigma by singling out those who are tested for HIV.
One result of the current process is that many people infected with HIV are not tested until they are already sick. This is because risk factor assessment has determined who gets tested but, unfortunately, fails to identify many people who are infected. Indeed, the thesis on which CDC's revised Recommendations is based is that HIV/AIDS is not exceptional, but rather, a treatable disease that meets the criteria for routine screening, e.g.,
- It is a serious health disorder that can be diagnosed before symptoms develop.
- It can be detected by reliable, inexpensive screening tests.
- Infected patients have years of life to gain if treatment is initiated early; and the costs of screening are reasonable in relation to the benefits (analyses show that routine testing for HIV is as cost-effective as screening for hypertension, colon cancer, and breast cancer).
Some of the challenges resulting from this exceptionalism, as well as other barriers to testing and care include:
- Declines in HIV incidence observed in the early 1990s have leveled and might even have reversed in certain populations in recent years.
- Although the introduction of highly active antiretroviral therapy has improve survival rates, progress in effecting earlier diagnosis has been improved only modestly: the proportion of people who first tested positive for HIV <1 year before receiving a diagnosis of AIDS was 39% in 2004 (19).
- Despite advances in HIV prevention and care, a substantial number of opportunities for HIV prevention are missed. Indeed, routine screening is rarely performed in health care settings in the United States.
- At publicly funded sites, approximately 70% of persons tested received their results and information regarding the test, but fewer persons likely received HIV prevention counseling and referrals. In private settings, a lower proportion of all clients are tested, and few receive prevention counseling and referrals (20-23).
- Delays in receiving testing results have resulted in barriers to learning one's HIV status. Rapid tests provide opportunities to dramatically increase the number of people who learn their HIV test results (24-25).