For the first time in Canada, a local health authority is advising all adults who engage in sex to be tested for HIV, rather than just those who engage in so-called "risky behaviour" known to lead to transmission of the deadly virus.
The bold recommendation by Vancouver public health officials and the B.C. Centre for Excellence in HIV/AIDS is designed to remove the stigma of AIDS testing.
They believe this will make dramatic inroads into the estimated 25 per cent of those who carry the disease but don't know it, leading them to pass the virus on to others.
Identifying this "hidden iceberg" of unsuspecting HIV-infected individuals will enable them to receive earlier treatment, thus significantly reducing the spread of AIDS, according to health authorities here.
"We are recommending to anyone who's been sexually active to get a test," said Vancouver's chief medical health officer, Patricia Daly. "This is a big departure. We don't know if it's going to work, but our hope is that we can change the nature of the AIDS epidemic."
The expanded new guidelines for having an HIV test will continue to include gay men, users of injected drugs and individuals with multiple partners, but also, for example, long-married couples living far from the big city.
"I've been married for 20 years and have three kids. Based on this recommendation, my doctor should be doing a test on me, too," Dr. Daly said Friday, as she and other officials unveiled the broadened guidelines.
By making an HIV test normal, infected individuals who have refused to be tested out of fear it would put them under suspicion of past, risky behaviour will reconsider, said Julio Montaner of the B.C. Centre for Excellence in HIV/AIDS.
"If you are a married man having sex with men, underground, you may not be willing to be tested," said Dr. Montaner, a past president of the International AIDS society, who has pioneered the benefits of aggressive, early treatment of HIV patients. "Right now, if I suggest you have an AIDS test, you may be offended. But if I tell you that everyone here at this coffee shop is being tested, that it's normal, your attitude will be different. At least, that's our hope."
AIDS testing has previously been targeted at higher-risk individuals because health officials thought universal testing would not be cost-effective, said Dr. Daly, given the few positive results that might arise among those with a lesser risk of contracting the virus.
In recent years, however, Dr. Montaner has demonstrated to a once-skeptical AIDS community the virtue of early treatment, both in maintaining a patient's health and weakening the virus so that the chance of it being passed on is lessened.
As a result of his findings, local health officials say it is now even more vital to identify as many HIV-positive individuals as possible.
"Before, we thought there was no real benefit from treating people early. That has changed," said Dr. Daley. "So we are launching this program and we intend to evaluate it, to see whether the number of new infections we uncover was worth it."
Over time, said Dr. Montaner, the more people with HIV who receive aggressive, early treatment, the smaller the pool of potential virus donors.
"If we do these new testing guidelines well, we should be able to find a substantial number of undiagnosed patients," he said. "So we are hoping to lead the rest of the country by example. It's foolish not to do it. If you could find everyone with the AIDS virus and give them the treatment, you could eliminate the HIV epidemic."