Background:  The Centers for Disease Control and Prevention (CDC) estimate that about one quarter of the 1.0 million to 1.2 million persons living with HIV/AIDS in the United States are unaware of their HIV infection status, and late diagnosis of HIV infection is common. Persons who do not know they are HIV-infected are unable to access effective care and treatment to reduce morbidity and mortality and are more likely to transmit HIV to others than those who are aware of their infection status. Pregnant women need to know if they are HIV-infected to take advantage of effective interventions to prevent HIV transmission to their children and to access care for themselves. Despite current CDC recommendations for routine, voluntary HIV testing of all pregnant women and for all persons in high HIV-prevalence medical care settings and those with risks for HIV in low HIV-prevalence medical care settings, many people who encounter the health care system are not HIV tested.   

Conclusions:  Promoting routine HIV testing in medical settings is a key strategy of CDC’s initiative, Advancing HIV Prevention: New Strategies for a Changing Epidemic, launched in 2003. CDC is in the process of revising recommendations for HIV testing in health care settings, with a goal of increasing the proportion of HIV-infected Americans who know their infection status to allow for linkage to prevention, care, and treatment services. Consideration is being given to recommending routine HIV screening in various health care settings based on cost-effectiveness analyses of different scenarios (including varying HIV prevalence), periodic rescreening for individuals with various risk indications, the type of counseling associated with testing in health care settings, the voluntary “opt-out” consent procedure for HIV testing as part of the consent for general care, and enhancing linkages to care and treatment. Expanded rescreening in the third trimester for women found to be HIV-negative early in pregnancy is also under consideration. CDC expects to issue revised recommendations in 2006.