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Routine testing for AIDS

IN THE United States today, AIDS no longer manifests itself in thousands of emaciated faces and certain death. The warning from New York City that health workers may have discovered a fast-developing, treatment-resistant variation is a reminder that the disease lurks throughout society and remains a serious public health problem.

New York officials have been criticized for overreacting to one case. They are now testing sex partners of the patient with the fast-acting virus to determine whether the new strain has spread.

Even in the absence of a deadly new strain, it is troubling that, according to the US Centers for Disease Control and Prevention, 43,000 Americans contracted AIDS in 2003, the last year for which data are complete, and 18,017 died. AIDS, a product of blood-to-blood transmission or sexual contact, is easily preventable. Some people have been lulled into carelessness by the success of drugs in controlling the virus over the last decade. The New York patient, for example, was under the influence of crystal methamphetamine when he had sex with many partners without using a condom.

According to the Centers for Disease Control, 850,000 to 950,000 people in the United States are living with HIV, including 180,000 to 280,000 who do not know that they have been infected. Ignorance, as well as carelessness, encourages the spread of the disease.

Sex among men remains the leading cause of AIDS transmission, according to the CDC. Heterosexuals are at risk as well, especially those who share needles. And while antiviral medicines usually control the disease, a small number of patients find that they are ineffective.

In response to the warning from New York, the AIDS Action Committee of Boston is urging everyone to practice safe sex; anyone using crystal methamphetamine to get help for the addiction; and all to know their HIV status.

This last bit of advice dovetails with recommendations of physicians writing in Feb. 10 issue of The New England Journal of Medicine, who urge that testing for HIV become an ordinary part of physical exams, perhaps every three to five years. People who know they are infected are less likely to spread the disease. One of the medical teams estimated that the number of HIV cases reported annually would decline by 21 percent.

It is important that the testing not lead to discrimination against anyone who is found to be infected with HIV. But with adequate privacy protections in place, physicians and patients should treat the procedure as essential, just as they would screening for cholesterol or cancer. Testing ought to be widespread and routine to keep this killer under control.

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