In preparation for National HIV Testing Day on June 27, the US Centers for Disease Control and Prevention (CDC) launched a new initiative on June 17 entitled "HIV Screening: Standard Care." To facilitate implementation of the 2006 CDC screening recommendations for incorporating HIV testing into routine medical care, the initiative includes physician, as well as patient, resources.

The 2006 recommendations for HIV screening are that all patients aged 13 to 64 years be routinely tested for HIV at least once, regardless of perceived risk, and that those at high risk because of multiple or HIV-infected partners or other risk factors be tested at least annually.

Newly available resources for primary care settings include an annotated physician's guide delineating the CDC's recommendations and the underlying rationale, a patient brochure and poster explaining the need for HIV screening, and a new Web page on the CDC's Act Against AIDS Website, from which physicians can request additional information and order resources.

"Many HIV-positive individuals walk out of their doctors' offices every day without knowing they have HIV," Jonathan Mermin, MD, MPH, director of the CDC's Division of HIV/AIDS Prevention, said in a news release. "We know that physicians must provide an enormous amount of care during brief patient visits, so we developed 'HIV Screening: Standard Care' to make it as easy as possible for doctors to routinely provide HIV testing to patients."

A 2009 survey of primary care physicians showed that only 17% perform routine HIV screening, missing a potentially great opportunity to detect asymptomatic patients with HIV infection, considering that about 72% of Americans report having had a routine checkup in the previous year.

"It is critical that we adopt routine HIV testing for our patients," said Amir Qaseem, MD, PhD, MHA, FACP, senior medical associate of the American College of Physicians and a member of the initiative's clinical workgroup. "As physicians, we play a crucial role in identifying those who are HIV-infected, providing timely treatment and care to extend their lives and helping them prevent transmission."

Approximately 1 in 5 Americans infected with HIV (more than 200,000 people) are unaware of their status and are responsible for more than half of all new sexually transmitted HIV infections, according to CDC estimates. Because individuals known to be HIV-positive are more likely to take appropriate action to prevent infecting their partners, detecting this infection in asymptomatic individuals is a worthwhile goal.

The CDC cites the following barriers to HIV screening:

• high demands on physicians, coupled with "scarce time and resources,"
• laws in some states that prohibit routine HIV testing, and
• need for improved physician education regarding screening.

Another advantage to early diagnosis is to ensure that HIV-infected individuals get appropriate care and treatment earlier, when antiretroviral treatments are more likely to be effective, thereby improving survival and quality of life. Although nearly one third of those diagnosed with HIV infection develop AIDS within 1 year of diagnosis, CDC data suggest that these individuals were infected for about 10 years before diagnosis.

"HIV Screening: Standard Care" is the most recent phase of the CDC's Act Against AIDS, a 5-year, $45 million initiative aimed at increasing HIV and AIDS awareness and screening, especially in high-risk communities. The American College of Physicians is convening several regional conferences this month to support the HIV screening initiative. The National Medical Association, Society for General Internal Medicine, HIV Medicine Association, and American Academy of HIV Medicine also endorse "HIV Screening: Standard Care."