“It's important to address the disparities in what's going on so that all Americans, regardless of color or sexual orientation, truly are considered important,” Dr. Sweet continued.
“We need to work to maintain their health, both by helping stop the spread of infections in our minority communities as well as making sure people in all communities have access to the best of care,” she said.
The strategy sets certain benchmarks to be reached by 2015, including lowering the annual number of new infections by 25%, reducing the HIV transmission rate by 30%, and increasing the percentage of persons living with HIV who know their serostatus from 79% to 90%.
“What the strategy is doing is asking the nation to use a tiered approach to HIV prevention so that certain interventions should be offered to everyone in the nation,” Dr. Mermin said. “Some interventions should be applied only to people at very high risk of acquiring HIV, such as intensive behavioral counseling or intensive case management that would take a lot more clinical or social resources. They should be reserved for people at the most risk. Some interventions should be offered to people with HIV, to help them reduce the chance that they are going to transmit HIV and to help them live longer, healthier lives.”
Not all HIV/AIDS leaders support the new national strategy. In a prepared statement, Dr. Michael Weinstein, president of the Los Angeles–based AIDS Healthcare Foundation called it a “real disappointment” and criticized it for lack of funding. He pointed out that as of July 9, 2,291 people in 12 states were on wait lists to receive medications through the nation's AIDS Drug Assistance Programs (ADAP).
“The vast majority of people in the United States who know that they have HIV are accessing care,” Dr. Mermin pointed out.
“We can increase that number over time. The Department of Health and Human Services is making efforts to address the ADAP waiting list. In the long run it's important that people with HIV do access high-quality care and prevention services. But just knowing that someone has HIV—even if it will be a few months before they can access care—is critical. People with HIV who know that they have the infection reduce their risk behavior by over 60%. So I think it's a mistake to say that there's no reason to screen for HIV anymore,” he said.
One challenge that worries Dr. Sweet is recruiting young physicians to the field of HIV/AIDS medicine.
“We're going to have an increasing problem finding doctors to take care of HIV/AIDS, simply because the people who have been doing this for 30 years are starting to age out,” she said. “It's tough to get young people into this, because it's in a group of people that are oftentimes socioeconomically disenfranchised, and they have a difficult time finding doctors anyway.”
'Some interventions should be applied only to people at very high risk of acquiring HIV.'
Source DR. MERMIN
Almost 25% of the nearly 1 million Americans with HIV 'are unaware of their HIV infection.'
Source DR. QASEEM
HIV Testing: Start the Conversation
Dr. Mermin suggested the following approach to starting the conversation on HIV testing with a patient: “The CDC recommends that all patients are offered an HIV test. Would you like to know your HIV status?”
That approach, known as opt-out offering of HIV testing, “is very successful,” Dr. Mermin said.
“Very few people will ask not to be tested under those circumstances. It takes the onus away from the provider to assess people's risk, and it takes the burden and awkwardness from the patient of having to raise the question of wanting an HIV test. Many patients don't know that they are at risk,” he told this newspaper.
The CDC testing initiative, which is supported by the American College of Physicians, the National Medical Association, the Society for General Internal Medicine, the HIV Medicine Association, and the American Academy of HIV Medicine, provides free a resource kit for physicians to use in primary care settings, including an annotated guide to CDC recommendations and the rationale for screening as well as patient materials such as brochures and posters.
To access the material, visit