TWO YEARS ago, the US Centers for Disease Control and Prevention broke with past policy and called for routine HIV testing among teens and adults up to age 65. The goal was to go beyond high-risk groups in order to identify more of the estimated 250,000 people who are unaware they are infected, and provide them with treatment and counseling to limit the spread of AIDS. Now it turns out the federal government is not following its own guidelines: Payment for routine testing is not included under the health insurance plan for 8.5 million federal employees or under Medicare, which covers 7.1 million disabled people under 65.
The disclosure last week by Bloomberg News of this failure is evidence that the federal government is not doing enough to limit transmission of this treatable - but still often fatal - disease. The Bloomberg report came just days before the CDC released a study showing that for several years it had been underestimating the number of new HIV infections among Americans.
Since the late 1990s, the CDC had pegged that number at 40,000 a year. But thanks to a new test that can tell how long the virus has been in a person's body when it is finally detected, officials now acknowledge that their estimate was off by about 40 percent - the number of infected Americans has been rising by 56,000 a year.
The new data point up how much harder public-health agencies and advocacy organizations have to work to prevent transmission of the virus, and they also demonstrate the value of testing to monitor the disease's spread and to gauge the effectiveness of prevention strategies. This makes it all the more frustrating that neither Medicare nor the Federal Employees Health Benefit Plan has seen fit to offer reimbursement for routine testing. Many big private insurers began offering payment for the tests soon after the CDC announced its guidelines.
There is still resistance to routine testing because of the stigma that surrounds AIDS. But the availability of effective drug treatments, especially when the disease is detected early, strengthens the case for widespread testing. The CDC specifically called for making the test voluntary; patients can opt out as they can for other tests. Another advantage of routine testing is that patients do not have to acknowledge their risky behavior to a doctor to qualify for a test.
The most disheartening fact about the revised CDC data on annual new infections is not their precise number, but that they are not declining. More routine testing could bring them down by alerting those who test positive that they are infectious. The federal government needs to be part of this effort.
