Overview

Of the 1 million people infected with HIV in the United States, an estimated 200,000 do not know they are infected.  Over 50,000 people are newly infected with HIV every year. To halt the spread of HIV, we must implement effective, broad-based screening for our general population.  This also holds for veterans.

On September 22, 2006, the Center for Disease Control (CDC) recommended reforms in HIV screening.  Put simply, everyone gets screened unless they choose to “opt out” of testing.

The Department of Veteran Affairs (DVA) is the nation’s largest single provider of HIV care.  During 2007 in meetings in Dallas in May and in Chicago in September, DVA clinicians, nurses, and social workers raised concerns and frustrations about barriers to HIV screening, and the need for Congress and allow the DVA to adopt the CDC recommendations. 

Bringing DVA into compliance with the CDC recommendations would require an act of Congress to  repeal the 1988 law requiring written informed consent prior to testing a veteran for HIV. 

In those dark days of the 1980s and early 1990s fear and prejudice ruled the epidemic.  People with HIV in their “hour of need” too often were abandoned by family and friends, lost their jobs and housing. 

In late 1995 our world as HIV doctors and patients began to change as new medications became available.   With “drug cocktails” blood levels of virus dropped from hundreds of thousands to levels that were nondetectable. Our patients’ blinding retinal infections, slowly suffocating lung infections, and spreading Kaposi’s sarcoma melted away.  Some of our patients teetering at the abyss did not make it, but for others the medications saved their lives. 

In transforming HIV from a nearly uniformly fatal diagnosis to a chronic disease, our medications are powerful tools.  Prevention remains our most powerful tool:  preventing the damage to people’s lives and cost to society. 

As physicians we have a moral duty not just to treat our patients infected with HIV, but to help halt the spread of HIV.  In 2008 Congress acted to repeal the 1988 requirement, allowing DVA staff to move forward to implement the CDC recommendations.

This website provides links and background information relating to CDC’s “Opt-Out” recommendations for HIV screening.

~ John Osborn, MD

HIV/AIDS Program

Spokane VA