Screening Tests for Adults (Ages 30-49)

Universal testing for human immunodeficiency virus (HIV) has become routine health care in the United States. Knowing your HIV status helps you protect your health. Many people do not realize that adults over 50 years of age make up 15 percent of new cases of HIV infection. Similarly, parents may not recognize that nearly half of all American teens as young as 13 years old have had intercourse at least once. Learning you are infected helps you get treatment that can greatly improve your health and extend your life. Also, you learn what reduces the chance you will pass the virus on to others. If an HIV screening test shows you’re not infected, you can take steps to avoid infection.

HIV is the virus that causes AIDS (acquired immunodeficiency syndrome), a deadly disease that is most often sexually transmitted. At least 90 to 95 percent of individuals who are infected with HIV will, within 3 months of exposure, develop enough antibodies to have a positive HIV test; over 99 percent of HIV-infected individuals will have a positive test within 6 months. If a pregnant woman is infected with HIV, the virus can be passed to and infect the fetus.

The U.S. Centers for Disease Control and Prevention (CDC) recommends screening for this infection as follows:

• Everyone 13 to 64 years old should have an HIV screening test at least once.
• Pregnant women should have at least one HIV test.

The CDC recommends getting tested each year if you’ve engaged in an activity that can spread an HIV infection.

Know your risk
Any of the following put you at risk and are a reason to have an HIV screening test soon, even if you have no symptoms of an infection, the U.S. Preventive Services Task Force and the American Academy of Family Physicians strongly suggest:

Sexual contacts of concern:

• If you’ve had unprotected sex with 2 or more people
• If you’re a male who, since 1975, has had sexual contact with another male
• If you or a partner exchanged sex for money or drugs
• If someone with whom you’ve had sex was HIV-infected, bisexual, or an injection drug user
• If you’re being treated for a sexually transmitted disease (STD)

Other issues of concern:

• If you use or used injection drugs (are likely to have shared unsterilized needles)
• If between 1978 and 1985 you had a blood transfusion

How often you are tested should depend on your activities and sexual contacts. For example, during a long-term, truly monogamous sexual relationship, you may want just one test. However, if you or your partner have had sexual contact with more than one person in recent months, your risk of infection is greater. If you or a person with whom you’ve had sexual contact (even unwanted sexual contact) engaged in some risky behavior, you have even more reason to be tested.

Talk to your health care provider
Don’t be surprised if a health care provider, in any care setting, asks you or your partner to consent to an HIV screening test, in keeping with CDC recommendations. Routine HIV testing (which you can decline or “opt out” of) prevents feelings of embarrassment or shame from becoming obstacles to crucial health care. This universal, nonjudgmental approach protects those who hesitate or never get to discuss sexual health issues with a health care provider. Those infected find out sooner; they can then get treatment when it works best and take steps to protect the health of sex partners and even their unborn children.

Some health care providers may be more selective about screening for HIV and other STDs. Instead of routinely offering all patients such tests, they may, as time and circumstances allow, assess your risk and then decide whether to suggest a screening test or tests. Unfortunately, some may not discuss sexual health issues at all. This leaves the health risks unchecked. If your health care provider does not bring up sexual health topics, you can simply ask for a test or a risk assessment. You can also use confidential services to obtain testing or counseling.

Links
For confidential information, you can call the STDs and HIV/AIDS hotline of the CDC: 800-232-4636.
National Library of Medicine: Online, narrated tutorial on STDs
Mayo Clinic: STD testing - What to know before your appointment

Sources

Biagioli FE and DeVoe JE. What are appropriate screening tests for adolescents? Oct 2006. J Family Practice 55(10):907-913. Available on the Internet through http://www.jfponline.com. Accessed 18 Jan 2008.

Branson BM, et al, for the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. 22 Sep 2006. MMWR 55(RR14):1-17. Available on the Internet at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm through http://www.cdc.gov. Accessed 28 Jan 2008.

US Preventive Services Task Force. Guide to Clinical Preventive Services, 2007. Available on the Internet at http://www.ahrq.gov/clinic/pocketgd07 through http://www.ahrq.gov. Accessed 28 Jan 2008.

Hagan JF, Shaw JS and Duncan PM, eds. Bright Futures Guidelines: Guidelines for Health Supervision of Infants, Children, and Adolescents. 2008. Elk Grove Village, Ill: American Academy of Pediatrics, pp. 169, 173.

National Institute of Allergy and Infectious Diseases, National Institutes of Health. HIV infection in adolescents and young adults (fact sheet). May 2006. Available on the Internet at http://www.niaid.nih.gov/factsheets/hivadolescent.htm through http://www.niaid.nih.gov. Accessed 25 Feb 2008.

US Centers for Disease Control and Prevention. Questions and answers for the general public: revised recommendations for HIV testing of adults, adolescents, and pregnant women in healthcare settings. Last modified 22 Jan 2007. Available on the Internet at http://www.cdc.gov/hiv/topics/testing/resources/qa/qa_general-public.htm through http://www.cdc.gov. Accessed 28 Jan 2008.