ABSTRACT
Reliable testing techniques for antibody to HIV were established and made widely available in developed countries by the mid-1980s, not long after the discovery of the virus. Since that time, several important factors have affected strategies for HIV testing. First and perhaps most important, it was soon obvious that the majority of HIV-infected individuals were asymptomatic and that clinical criteria were inadequate to diagnose early infection. The public health implications of this fact have been far reaching, since HIV can be transmitted throughout the course of infection. Second, advances in antiretroviral therapy as well as counseling strategies to reduce transmission have made it imperative to detect HIV infection as early in the asymptomatic phase as possible. Third, antiretroviral therapy can dramatically reduce the risk of mother-to-child transmission during pregnancy, childbirth, and breast-feeding if HIV infection can be diagnosed in the mother by the second or third trimester. Fourth, only by an understanding of the distribution of HIV infection in the population through seroprevalence studies can allocation of resources for prevention and medical care be focused. Fifth, prevention of transmission of HIV infection to health care workers by means of needlestick injuries and other potential exposures is facilitated by the rapid testing of the source patient. For all of these reasons, HIV testing efforts are undergoing an expansion in an effort to increase testing of individuals regardless of presumed risk of infection and also targeted to pregnant women. In the United States, several states have established mandatory testing programs for pregnant women and neonates. Partner notification and contact tracing efforts have been enhanced in some areas. Public education campaigns intended to increase testing among high-risk populations have been expanded, and legal protections have been developed to reduce discrimination against the HIV infected.
