Effective September 2006, CDC has revised its recommendations for HIV
testing in Health Care
settings. The Revised Recommendations for HIV
Testing of Adults, Adolescents, and Pregnant Women in Health Care
Settings aim to make HIV testing a routine part of medical care in
addition to expanding the gains made in diagnosing HIV infection among
pregnant women. The Recommendations replace CDCís 1993
Recommendations for HIV Testing Services for Inpatients and Outpatients
in Acute-Care Settings, and they update portions of CDCís 2001
Revised Guidelines for HIV Counseling, Testing, and Referral and Revised
Recommendations for HIV Screening of Pregnant Women.
What is different about the new Recommendations?
Key differences in the Recommendations for patients in all
Health Care settings are
- HIV screening (another term for broad-based testing) for patients ages 13 to 64 in all health care settings after the patient is notified that testing will be performed unless the patient declines
- HIV testing of people at high risk for HIV infection at least once a year.
- Screening should be incorporated into the general consent for medical care; separate written consent is not recommended.
- Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in Healthcare
Additional key differences in the Recommendations for pregnant women in
- Including HIV screening in the routine panel of
prenatal screening tests for all pregnant women, unless the patient
declines (opt-out screening).
- Repeat screening in the third trimester in
certain jurisdictions with elevated rates of HIV infection among
The Recommendations emphasize the importance of voluntary
testing. Various constituencies have expressed concern that eliminating
the recommendation for separate informed consent for an HIV test could
result in some patients being tested for HIV without their knowledge.
Others have asserted that requiring separate, written informed consent
is a barrier that makes HIV screening difficult to conduct in health care
settings, and that removing this requirement would make widespread HIV
Concerns have also been expressed over the lack of HIV prevention
counseling in conjunction with HIV testing. CDC continues to support
prevention counseling as an intervention to help people reduce their
risks for HIV, but recognizes it can become a barrier to HIV testing in
busy health care
settings. CDC still recommends that patients receive
information about HIV testing, HIV infection, and the meaning of test
results.Why did CDC revise the Recommendations?
There are several compelling reasons why CDC has revised the Recommendations.
For whom are the Recommendations intended?
- An estimated one fourth of the approximately 1 million persons
in this country who are living with HIV do not know they are
infected. Thatís approximately 250,000 persons who could be
spreading HIV to their partners unknowingly. As HIV screening
becomes a more routine aspect of medical care, more people will know
they are infected with HIV.
- People living with HIV can receive effective treatment,
resulting in improved health and extended life, if their HIV
infection is diagnosed earlier. Currently, many people learn of their HIV infection only after they have developed symptoms
(in a large study of HIV-infected persons, 65% reported they were first tested for HIV because of illness).
- Most people, after finding out they have HIV, adopt behaviors
that reduce HIV transmission. Routine HIV testing may help protect
the partners of persons who are living with HIV but do not know it.
In theory, new sexually transmitted HIV infections could be reduced
more than 30% per year if all HIV-infected persons knew of their
infection and adopted changes in behavior similar to those of
persons already aware of their infection.
- Routine HIV testing may reduce the stigma associated with an HIV
test offered based on the health care
providerís perception (or
knowledge) of risk. When every person gets offered an HIV test at
some point in his or her health care, it should take controversy and
judgment out of the test and make it a normal part of taking care of
- Providers reported that requirements for pre-test counseling and
written informed consent were not feasible in emergency rooms and
other busy health care
The Recommendations are intended for health care
both the public and private sectors. These include health care
in hospital emergency departments, inpatient services (including labor
and delivery), correctional health care facilities, clinics including
substance abuse treatment, and public health, community, pediatric and
adolescent, prenatal, mental health, and other primary care
These Recommendations address HIV testing in health care
settings only. They do not change existing CDC guidelines on HIV counseling, testing, and referral for persons at high risk for HIV who receive testing in nonclinical settings
(e.g., at community-based organizations.)
How did CDC develop the Recommendations?
These Recommendations are the culmination of a lengthy and
deliberate process that began in 1999 when the Institute of Medicine
(IOM) recommended adopting a national policy of universal testing of
pregnant women with patient notification (opt-out screening),
eliminating requirements for extensive pretest counseling, and
eliminating requirements for explicit written consent for HIV testing.
Adoption of the IOM recommendations led to increased prenatal screening,
and, combined with appropriate medical care, contributed to a dramatic
95% decline in perinatally acquired AIDS cases. CDC began exploring the
feasibility of adopting a similar policy for the general public, which
could bring about reductions in sexually transmitted HIV. Between 1999
and 2006, CDC involved health care
providers, representatives from
professional associations and community organizations, researchers,
public health officials, and persons living with HIV to research and
refine the Recommendations in order to expand HIV testing, especially in
high-volume, high-prevalence acute-care settings. Through this process,
CDC has tried to involve persons most likely to be affected by the
Recommendations and ensure the resulting Recommendations are ethical and
fair and would achieve their stated goals.Conclusion
CDC believes that the adoption of voluntary, HIV screening in
settings will foster the earlier detection of HIV infection,
help health care
workers identify and counsel persons with previously
unrecognized HIV infection and link them to clinical and prevention
services, and further reduce sexual and perinatal transmission of HIV in
the United States.