Twenty-five years into the AIDS epidemic, the U.S, Centers for Disease Control is changing its guidelines on HIV testing to encourage more routine screening among patients in the 50 states, whether or not they appear to fit into a high-risk group.

A quick look at a mix of newly reported and well-known epidemiological numbers tells you why.

The AIDS epidemic has been infecting Americans at a steady rate since about 1998—neither increasing very much nor decreasing very much. Each year since then there have been about 40,000 new HIV diagnoses, down from 150,000 per year in the late 1980s. 

“More than 1 million Americans are currently living with HIV/AIDS and nearly a quarter of these are still unaware of their HIV status,” Dr. Kevin Fenton, director of the National Center for HIV, STD, and TB Prevention, told reporters in a telephone briefing. “CDC estimates that most new HIV infections in the United States are transmitted by the 25% of people with HIV who do not even realize that they are infected.”

Meanwhile, routine testing (and treatment) of pregnant women has made a dramatic difference in the number of newborns who are infected with HIV. Currently, about 300 babies are born each year in the U.S. with HIV, down from about 2,000 per year in the early-to-mid 1990s. Health officials would like to replicate their success with pregnant moms to the population at large.

In some ways, the CDC’s new recommendation on routine testing is a reflection of how much the epidemic has changed. The infection need no longer be an automatic death sentence, although treatment can be grueling and doesn’t always last. Experience in Botswana and other countries suggests that treating HIV testing differently from other medical-screening measures can actually increase the level of stigma rather than decrease it.

In addition, 43 states now have confidential name-based reporting of HIV diagnoses, according to Fenton. The CDC has also put into place a new nationwide system to more accurately estimate new HIV infections. The first results of this system will be reported later this year.

—Christine Gorman