Reports on HIV/AIDS: 1990

MARCH 9, 1990, MMWR, Vol. 39, No. 9, pp. 137-140
Editorial Note: Of all HIV prevention efforts, counseling and testing activities receive
the highest level of resource support from CDC. The data reported here indicate a
large and increasing demand for HIV counseling and testing in the United States;
from January 1988 through September 1989, one in 22 persons seeking publicly
funded HIV counseling and testing services were confirmed to be infected. Knowledge of HIV-infection status and appropriate counseling can assist persons in
initiating changes in behavior that will reduce the risk of infecting others or of
becoming infected (1,2). Positive behavioral changes can also occur in the large
number of persons who elect not to be tested but who receive risk-reduction
counseling. In addition, early detection of HIV infection and referral (3) can lead to
optimal medical management and partner notification.
Because of duplicate testing, the total number of persons tested and found to be
HIV-antibody positive in U.S. publicly funded settings is not known.t However, four
publicly funded HIV prevention programs that have monitored repeat tests estimated
that 12%-30% (mean: 23%) of HIV-antibody tests and 3%-18% (mean: 13%) of positive tests represented previously tested persons (CDC, unpublished data). When these
rates are applied to the data reported here, an estimated 2 million persons have been
tested since 1985 through publicly funded counseling and testing programs, and
123,000-145,000 persons have been found to be infected.
Many of the estimated 1 million HIV-infected persons in the United States remain
unaware of their infection (4). Of persons who are aware of their HIV infection, a
substantial proportion had their infection identified in publicly funded counseling and
testing programs.
To ensure that persons with undetected HIV infection receive appropriate counseling and testing, priorities should include increasing the number of persons,
especially those engaging in risk behaviors, who come to the test sites and the
number of persons who receive the fuli range of counseling and testing, referral, and
partner notification services. Programs should attempt to maximize the proportion of
persons at risk who 1) are offered and receive pretest counseling; 2) accept and
receive HIV-antibody testing; 3) return for HIV-antibody test results; 4) are offered and
receive post-test counseling; 5) if infected, participate in partner notification; and 6) if
infected, are referred for and receive further medical and prevention services.
References
1. Cates W Jr, Handsfield HH. HIV counseling and testing: does it work? Am J Public Health
1988;78:1533-4.
2. Stempel RR, Moss AR. A review of studies of behavioral response to HIV-antibody testing
among gay men [Poster session]. V International Conference on AIDS. Montreal, June 4-9,
1989:730.
3. Francis DP, Anderson RE, Gorman ME, et al. Targeting AIDS prevention and treatment toward
HIV-1-infected persons. JAMA 1989;262:2572-6.
4. CDC. Estimates of HIV prevalence and projected AIDS cases: summary of a workshop,
October 31-November 1, 1989. MMWR 1990;39:110-2,117-9.
tIn addition to the tests reported here, a large but unknown number of persons are tested for HIV
antibody in hospitals, outpatient medical facilities, physicians' offices, blood-donation centers,
military facilities, and other settings.

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