title: Assessing targeted screening and low rates of HIV testing.
abstract: OBJECTIVE
  We assessed rates of HIV testing based on targeting patients with identified risk factors at the Veterans Affairs Medical Center in Washington, DC (VAMC-DC), where written informed consent along with pretest and posttest counseling had, until recently, been required by federal law.
  
  
  METHODS
  A cumulative retrospective review of the period 2000 through 2007 was conducted to assess the number of patients who were provided medical care at VAMC-DC, tested for HIV, and underwent confirmatory testing. Data on demographic characteristics and risks for HIV acquisition were also collected.
  
  
  RESULTS
  At VAMC-DC, 3.8% to 4.9% (mean=4.25%) of patients in care without known HIV infection underwent HIV screening annually. On average, HIV was confirmed at a yearly rate of 3.4% among those tested. During the study period, HIV prevalence ranged from 2.1% to 2.5%. Among patients receiving HIV care, 41.5% disclosed no risk factors for HIV acquisition.
  
  
  CONCLUSIONS
  Given that the HIV prevalence observed in this study was above 2% and that 41.5% of patients in care did not disclose any acquisition risks, targeted HIV screening has not been sufficient. HIV testing must be broadened and offered as part of routine medical care.
authors.affiliation: Infectious Diseases Section (151B), VA Medical Center, 50 Irving St, NW, Washington, DC 20422, USA.
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Kennedy
authors.forename: Fred M
authors.initials: FM
authors.lastname: Gordin
authors.forename: Virginia L
authors.initials: VL
authors.lastname: Kan
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D003376:Counseling; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*