AIDS and the unknown

TWO YEARS ago, the Centers for Disease Control and Prevention recommended that health providers offer voluntary HIV testing on a routine basis, much like cholesterol screening. The goal was to reduce the high proportion - more than 20 percent - of infected persons who do not know they carry the virus. Not only do they get no treatment, but they are also more likely to infect others.

But the CDC recommendation has had only limited effect. A recent survey of the country's approximately 5,000 emergency rooms found that no more than 100 routinely offer HIV tests to patients they treat. It is particularly important that emergency room personnel provide the test, because the population most likely to carry the virus that causes AIDS seeks medical care at emergency rooms more often than at doctors' practices. Today, World AIDS Day, public health officials should recommit to the CDC goal of near-automatic testing.

A study at a forum on HIV research last month in Washington indicated that, while most emergency room patients accept routine HIV testing, a majority of emergency room personnel say they oppose it. This is likely because they feel they are too busy to offer the test, and worry about counseling they might have to provide.

Dr. John Bartlett of Johns Hopkins University said another hurdle is the requirement in several states, including Massachusetts, that patients sign a written consent before getting the test. States passed such laws in the early days of the disease, when there was no treatment and the stigma attached to AIDS was greater than now. Some stigma still exists. Eleven states that once had written-consent laws have dropped them.

The Massachusetts Department of Public Health is trying to increase testing with pilot programs at a hospital emergency room, an urban community health center, and a high-volume private doctors' practice. The department is also distributing a new brochure about the test and the disease, and has drawn up a model consent form that is less complicated and daunting than the documents some healthcare facilities use.

About 1.1 million Americans are thought to be HIV-positive, and each year an additional 56,000 become infected with the disease. More widespread testing could reduce the number of new infections in two ways. Those who learn they are infected could stop sharing contaminated drug needles and adopt safer sex practices. Also, by getting effective early treatment, they would be less likely to transmit the disease.

The United States has stumbled in several ways in its response to AIDS. The failure to follow through aggressively on the CDC's call for routine testing is inexcusable.