THE CENTERS for Disease Control is proposing that tests for HIV, the virus that causes AIDS, be made a routine part of physical examinations for everyone between the ages of 13 and 64. The proposal is sure to offend many people, especially those who think taking an HIV test would lump them together with homosexuals, IV drug users and other people whose choices put them at risk of AIDS.
But the CDC has good reason for proposing expansion of HIV testing, both to protect patients and to protect medical personnel.
The agency said last week that almost half of new HIV cases are diagnosed when doctors are treating patients who are sick with unidentified illnesses. Many cases are not diagnosed until the later stages of the disease, when the effective therapies for controlling HIV infections are no longer so effective.
Undiagnosed HIV is dangerous not only to patients, but also to the doctors and nurses who treat them for their illnesses. If each person’s HIV status was part of a standard medical exam, doctors would be better able to diagnose and treat their patients.
Does the proposal sound extreme? The United States is no stranger to large public-health programs. It is not all that long since most American schoolchildren were routinely vaccinated against smallpox and regularly tested for tuberculosis. Just over 50 years ago, when the first vaccine was developed to protect children against polio, doctors and nurses were mobilized to vaccinate every child in the country. The results of those tests and vaccinations were amazing. Smallpox was eliminated, tuberculosis was beaten back and polio ceased to be a frightening threat to the health of the nation’s children.
Widespread HIV testing could go a long way to curtailing the spread of the disease.
There are no technological barriers to the CDC proposal. HIV tests are widely available and reliable.
The primary practical obstacle is economic. Rising medical costs and the declining effectiveness of health insurance are making people increasingly reluctant to undergo any tests that do not seem to be absolutely necessary.
Add to the cost the natural reluctance of most people to think of themselves as at any risk at all from HIV infection, and it does not seem likely that any sort of national screening program will be established soon.
Still, a screening program is worth considering.