Opt-Out HIV Screening Should Be Routine, Expert Says

   "Its important that, as good internists, family practice, general doctors who are trying to take the best care possible of our patients, we understand that life is full of sexual behavior and that many of our patients do not feel comfortable bringing that up." So said Donna Sweet, MD, in an interview secondary to her presentation at Internal Medicine 2011, the annual meeting of the American College of Physicians in San Diego.

   Dr. Sweet is Professor of Medicine at the University of Kansas School of Medicine at Wichita and a prominent HIV treater. She spoke on routine HIV testing, a matter on which she is especially insistent.  “One of our passions at ACP and mine personally is to get routinization of testing and get people into care before they get so sick,” she said. 

   “In September of 2006 the CDC put out new  guidelines that every person who’s between 13 and 64 who’s ever been sexually active needs a routine, opt-out HIV test, not one that’s risk based. Everyone needs to know their status.

   “The problem is that we have well over 220,000 people in this country who are HIV infected and don’t know it. We also know from some very good sociological and social work data that they are responsible for probably 60% to 70% of the new infections. We have a new infection every nine and a half minutes. We have 56,000 people getting infected every year. We really need to find the people who are infected, not only for their own health to get them on truly life saving therapy that we have in this day and age but also so that they know how not to infect others.”

   So patients may not be comfortable bringing up sexual issues, but their physicians must, Dr. Sweet says. “It’s our job to learn to talk about these issues and to bring it up for them. Most importantly, HIV screening is something that needs to be done and you have to figure out how to get it into your practice just as you figure out out how to make sure that your women get mammograms and your men get PSAs.

   “We have medication that can give you, almost, a normal lifespan if you get on it right and take it well,” she said. And in many cases the regimen is one pill a day, not the handful that had to be taken on a complicated schedule a decade ago.