CDC's new strategy to increase HIV testing is drawing limited praise but more opposition because it would unlink HIV testing from counseling and move more testing into medical settings where patients may not receive the full range of counseling available at AIDS and community-based groups. Ronald Johnson, associate executive director at New York City-based Gay Men's Health Crisis, said, "From what I have read about the initiative ... it does not meet the needs of the populations that GMHC serves."

"We think that HIV pre-test counseling is an important component of HIV testing," said Michael Cover, spokesperson for the Washington-based Whitman-Walker Clinic, which last year performed about 7,000 HIV tests. GMHC performs roughly 1,600 HIV tests each year, according to testing director Dr. Patricia Kummel. Nearly 100 percent of GMHC's clients return for their test results, and an equal number who test positive are referred to GMHC services, Kummel said. "I think it's the connection that our counselors make during the testing process," she said.

AIDS groups also objected to an increased emphasis on testing pregnant women, which might include a default assumption that mothers have consented to HIV testing unless they opt out. That looks like mandatory testing, which advocates have long opposed. At the April 17 briefing, CDC Director Dr. Julie Gerberding repeatedly said CDC opposes mandatory testing. "Prenatal transmission has been so reduced in this country ... that the need for this kind of across the board intervention is questionable," Johnson said. But CDC's Dr. Ronald O. Valdiserri, deputy director of the National Center for HIV, STD and TB Prevention, said in response to e-mailed questions, "The birth of 300 children a year with [HIV] ... is unacceptable. Routine testing of pregnant women is just one of many strategies being undertaken to help reduce the number of HIV infections in the United States each year."

AIDS groups were told in a different April 17 briefing that CDC will steer one-quarter of its $636 million domestic HIV prevention funds into these new strategies, according to David Munar, associate director at the AIDS Foundation of Chicago. "All of these activities like condom distribution, street outreach that are currently funded won't be," Munar said. While his group approves of some of CDC's goals, "We don't think they should be occurring at the expense of health education and risk reduction activities. We're very concerned that defunding those activities is a step backwards," Munar said.

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