Hospital-Based Routine HIV Testing Programs

Abstract

The debate about the risks and harms resulting from the diagnosis of an asymptomatic human immunodeficiency virus (HIV) infection was resolved, at least for adults, after the demonstration of sufficient benefit from zidovudinel and pneumocystosis prophylaxis.2 Now we must promote the HIV testing necessary to apprise asymptomatic HIV-infected persons of their status. To this end, HIV counseling and testing sites are widely available. But these sites require untested persons to come forward. Furthermore, since the benefits of detecting an HIV infection cannot be realized practically without entering a healthcare system, there is no rational benefit to the anonymous testing they can provide. Public health officials have recommended hospital-based programs for certain generally advocated medical activities, such as immunization.3,4 This editorial considers hospital-based, routine HIV testing programs as a way of effecting broader HIV screening. The choice of hospitals for routine HIV screening is demographically disadvantageous. HIV infection is overrepresented among young adults and those without adequate health insurance. Except for those ill with HIV disease, these two groups are underrepresented among hospitalized persons. But there is insufficient recognition that the institution of screening programs can be considered on a location-specific basis. For instance, in a recent analysis of the cost and benefits of premarital screening, Centers for Disease Control (CDC) authors considered only the national aggregate.5 More challenging and relevant judgements should have been offered about the prevalence threshold