Nothing to Lose: A Harm Reduction Approach to Routine HIV Testing

Abstract

In September 2006, the Centers for Disease Control and Prevention (2006) published recommendations for universal voluntary routine HIV testing in the United States. The recommendations encouraged legal, institutional, and clinical practice changes to make HIV testing more convenient for both providers and patients, and many changes have been implemented (Bartlett et al., 2008). Despite these changes and the support of professional organizations (Association of Nurses in AIDS Care, 2008; Qaseem et al., 2009), however, a national conference on routine HIV testing in December 2008 reported little progress in implementation of the recommendations (Forum for Collaborative HIV Research, 2008). Universal voluntary routine HIV testing is a winwin idea. Voluntary (or opt-out) testing preserves patient autonomy and transparency in personal health care. Universal and routine testing can find people with HIV infection earlier, which will decrease the number of late testers who present with advanced and difficult-to-treat disease. Universal testing can help guide HIV-infected people into care at an earlier point when they are better able—physically, mentally, and emotionally—to engage in care. Routine testing can increase prevention efforts by making HIV an issue for everyone and by helping HIV-infected people learn about transmission and protective measures for their sex and drug-using partners. There is even evidence that HIV testing for everyone older than 13 years, accompanied by imme-