Background At the end of 2006 (the most recent year that data are available), an estimated 1 106 400 persons in the USA were living with HIV infection, with 21% undiagnosed. In September 2006, the Centers for Disease Control & Prevention (CDC) released new guidelines recommending routine HIV screening of adults, adolescents, and pregnant women in health care settings and reducing barriers to HIV testing. According to the 2009 city report, 3% of Washington, D.C., residents were infected with HIV or AIDS - a figure that ranked as the highest in the nation and far exceeded the 1% benchmark at which a disease becomes a “generalised and severe” epidemic.

Methods In July 2009, the SE STD Clinic, the only publicly funded STD clinic in Washington, DC, began providing opt-out HIV testing. All clients who were not previously known to be HIV infected and had not been tested in the previous 30 days were screened using the OraQuick ADVANCE Rapid HIV-1/2 Antibody Test. Disease Intervention Specialists (DIS) ceased pre-test counselling and written consent for HIV testing was incorporated into the general consent form.

Results From July 2008 through June 2009, 9537 unique clients visited the SE STD Clinic, of which 5972 (62.6%) were screened for HIV, 2558 (26.8%) were deemed ineligible, and 1007 (10.6%) refused. Of those tested, 48 (0.8%) were positive—35 (72.9%) were new infections, 11 (22.9%) were previous positives, and 2 (4.2%) were false positives. From July 2009 through June 2010, 12 154 unique clients visited the SE STD Clinic, of which 9702 (79.8%) were screened for HIV, 2039 (16.8%) were deemed ineligible, and 413 (3.4%) refused. Of those ineligible, 1832 (89.8%) had been tested in the previous 30 days, 197 (9.7%) were previous positives, and 10 (0.5%) were listed as Other.” Of those tested, 89 (0.9%) were positive—59 (66.3%) were new infections, 25 (28.1%) were previous positives, 2 (2.2%) were false positives, and 3 (3.4%) were “Out of Jurisdiction.”

Conclusion “Routinisation” of HIV screening among this high-risk population increased the percentage of clients tested, decreased the percentage of clients that were ineligible or refused screening and increased the number of new infections identified (0.37% vs 0.49%, respectively). From July 2009 through June 2010, 3730 more HIV tests were conducted (compared to July 2008 through June 2009) identifying 14 additional new HIV infections.”