ATLANTA - The teenager who hasn't had a date. The woman married 30 years to a devoted husband. The celibate priest.
These are among the millions of Americans who may soon undergo their first HIV tests - not because of any high-risk behavior, but because federal officials believe testing should be routine for all Americans ages 13 to 64.
The U.S. Centers for Disease Control and Prevention announced the new recommendations Thursday. CDC officials said they aim to prevent the further spread of the disease and prompt needed care for an estimated 250,000 Americans who have the AIDS virus but don't know it.
"We simply must improve early diagnosis," CDC Director Dr. Julie Gerberding said.
Nearly half of new HIV infections are discovered when doctors are trying to diagnose a patient who has already grown sick with an HIV-related illness, CDC officials said.
"By identifying people earlier through a screening program, we'll allow them to access life-extending therapy, and also through prevention services, learn how to avoid transmitting HIV infection to others," said Dr. Timothy Mastro, acting director of the CDC's division of HIV/AIDS prevention.
Although some groups raised concerns, the announcement was mostly embraced by health policy experts, doctors and patient advocates.
"I think it's an incredible advance. I think it's courageous on the part of the CDC," said A. David Paltiel, a health policy expert at the Yale University School of Medicine.
The recommendations aren't legally binding, but they influence what doctors do and what health insurance programs cover.
However, some doctors' groups predict the recommendations will be challenging to implement, requiring more money and time for testing, counseling and revising consent procedures.
Some physicians also question whether there is enough evidence to expand testing beyond high-risk groups, said Dr. Larry Fields, the president of the American Academy of Family Physicians.
"Are doctors going to do it? Probably not," Fields said.
The recommendations were endorsed by the American Medical Association, which urged doctors to comply. The CDC said it's difficult to predict how many doctors will.
Previously, the CDC recommended routine testing for those at high risk for catching the virus, such as intravenous drug users and gay men, and for hospitals and certain other institutions serving areas where HIV is common. It also recommended testing for all pregnant women.
Under the new guidelines, patients would be tested for the AIDS virus as part of the standard tests they get when they go for urgent or emergency care, or even during a routine physical.
The CDC recommends everyone get tested at least once, but annual testing is urged only for people at high risk.
Consent for the test would be covered in a clinic or hospital's standard care consent form. Patients would be allowed to decline the testing. The CDC's guidelines say no one should be tested without their knowledge.
An American Civil Liberties Union official protested the CDC's idea of dealing with HIV on standard consent forms, and the agency's de-emphasis of pre-test counseling.
"By eliminating these safeguards, what they're calling 'routine testing' will in practice be mandatory testing," said Rose Saxe, a staff attorney with the ACLU AIDS Project.
Doctors should tell patients anonymous testing is also available, if they'd rather choose where they want to get HIV testing, Saxe said.
The cost of the new policy is not clear. A standard HIV test can cost between $2.50 and $8, public health experts say.
New rapid tests cost about $15. If an initial result is positive, confirmatory tests can cost another $50 or more. Treatment for HIV can cost more than $10,000 a year.
WellPoint, the Indianapolis company that owns 14 Blue Cross and Blue Shield plans across the country, has not yet taken a position on the CDC guidelines.
It also hasn't estimated what it will cost to expand HIV testing for its 34 million members, but it traditionally covers tests recommended by the CDC, said WellPoint spokeswoman Shannon Troughton.
The recommendation, if fully implemented, could mean testing for to 100 to 200 million Americans, said Ron Spair, chief financial officer of Pennsylvania-based OraSure Technologies, one of three companies that sell rapid-result HIV tests in the United States.
The other companies are MedMira Inc. and Trinity Biotech. Standard HIV tests are done through both public health labs and private and commercial labs.
"This certainly expands the rapid HIV testing market," Spair said.
Identifying more HIV patients will place an added burden on public health programs that pay for such care, some of which are facing potential cuts under a proposal before Congress. But more diagnoses may help win bolstered funding, said John Peebles, an assistant branch chief over HIV programs at the North Carolina Department of Health and Human Resources.
"If you don't know what you need, you can't make the argument for resources," Peebles said.
The CDC has been working on the guidelines for about three years, and got input from more than 100 groups, including doctors' associations and HIV patient support groups.
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