The HIV Test at 30: More Essential than Ever

Ed. note: This is cross-posted on the AIDS.gov blog. See the original post here.

Early in the AIDS epidemic, there was so much we didn’t know — what caused the disease, how it was spread or how to treat it. But, once scientists were able to isolate and establish a virus — HIV — as the cause of AIDS, that all began to change.

For one thing, knowing what to look for allowed scientists to begin developing a test to detect HIV. Thirty years ago today — on March 2, 1985 — the U.S. Food and Drug Administration approved the first commercial HIV blood test. This was a major breakthrough. Testing meant that the blood supply could be essentially freed of HIV, and helped scientists and public health officials determine the extent of the epidemic. Testing also gave individuals the power of knowing their status, and enabled them to protect their partners, if infected.

Early on, CDC-funded HIV counseling and testing performed by health departments was one of the few ways for individuals-at-risk to get an HIV test, but by the end of 1985 only an estimated 79,000 tests had been conducted — this, at a time when hundreds of thousands of Americans were living with the virus.

With only limited treatment available for HIV, a positive HIV test often came with little hope and foreshadowed a painful decline. Fear ran rampant. Ryan White, a 13-year-old child living with HIV, was banned from his middle school. Some New Yorkers confessed concerns about going to restaurants where gay waiters might serve them. The cover of Life Magazine blared, “Now No One is Safe from AIDS.”

In this environment, simply getting to an HIV testing site often felt like a risk. People didn’t want to run into someone they knew, someone they worked with, someone they might meet tomorrow. And, many people avoided testing because they were simply afraid to know the results.

Plus, testing was a slow, drawn-out process. Early tests required two clinic visits over two weeks: First for pre-test counseling and blood draw, and later, for the results and post-test counseling. In some places, more than half of the people tested never returned to get their results.

However, times have changed and technology has evolved. Laboratory tests can now detect HIV infection within a few days after exposure, compared with three to six months with early tests. This is critical because in the immediate aftermath of infection — called acute infection — HIV rapidly multiplies in the body and is most easily passed on to others. Being able to test for acute infection helps more people know they’re infected earlier — and allows them to protect their health, and their partners, sooner.

In addition, we now have rapid HIV tests that can be conducted outside of a laboratory and provide preliminary results in just a few minutes, as well as home test kits that are available for purchase over the counter and can be used in a private setting.

Compared with 30 years ago, people who test positive — and their partners — have many more options. Vastly improved treatments can help people who have HIV live long, healthy lives and dramatically reduce the chance of passing the virus on to others.

The benefits of HIV testing have only increased. Research shows that people who are aware they have HIV are substantially less likely to engage in risky behavior than those who are not — and people who receive HIV medical care are far less likely to transmit the virus to others. In fact, recent CDC analyses show that 9 in 10 new HIV infections could be prevented if every person living with HIV was diagnosed and getting medical care for their infection.

Today, HIV testing is at an all-time high. Due to testing advances and intensified efforts to reach more people unaware of their infection, 86 percent of people with HIV know they’re infected. But there’s still work to do — more than 186,000 individuals with HIV in the United States still don’t know they’re infected.

That’s why CDC is providing free resource kits that help primary care providers make HIV testing a routine part of health care — as routine as a cholesterol check. We’re expanding outreach to those at highest risk for HIV through testing campaigns that focus on gay and bisexual men (especially Latinos and African Americans), African American women, and young people to encourage HIV testing – and making fast, free, confidential testing easy to find for everyone.

To help ensure that those who test positive get the care and treatment they need to stay healthy and avoid passing the virus to others, we’re also focusing on what happens after diagnosis. We’re leading a national communication campaign to encourage treatment and care for people living with HIV. We’re supporting training for health care providers across the country to help newly diagnosed people create personal plans for staying in care and treatment, and counselors are even accompanying those newly diagnosed to a health clinic or doctor’s office.

Ensuring that every American knows their HIV status is the first critical step toward helping people living with HIV take care of themselves and others. While much has changed over the course of the epidemic, the HIV test — a scientific breakthrough achieved three decades ago — is now more essential than ever.

Jonathan Mermin, M.D., M.P.H., is the Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the Centers for Disease Control and Prevention.