Changing epidemiology of HIV/AIDS in the United States: implications for enhancing and promoting HIV testing strategies.

Despite aggressive prevention efforts, > 1 million people in the United States are currently estimated to be living with human immunodeficiency virus (HIV) infection, with or without progression to acquired immunodeficiency syndrome (AIDS). Although men who have sex with men remain the group at highest risk, updated prevention strategies need to take into account the changing face of the epidemic, notably, the increasing burden of the disease among African Americans and young people. One of the major obstacles to current efforts in the United States to prevent HIV infection is the high rate of transmission among people who do not know they are infected. Many Americans still receive a diagnosis of advanced HIV disease, including AIDS, < or = 1 year after HIV infection is diagnosed, suggesting that they have been HIV positive and unaware of their serostatus for 5-10 years. Promoting access to and receipt of HIV testing is one of the Centers for Disease Control and Prevention's 4 main strategies for advancing efforts to prevent HIV infection. Making HIV testing a routine part of medical care would lead to earlier diagnosis of infection. This would in turn improve the prognosis for the infected individual and reduce the risk of onward transmission, particularly if effective counseling, education, and treatment are provided upon diagnosis. New recommendations aimed at making HIV testing more routine in health care settings should have a substantial impact on these efforts, but it is crucially important that our strategies reflect the changing face of the epidemic.