July 31 (Bloomberg) -- The U.S. government is ignoring its own guidelines for HIV screening, putting more than 15 million people covered by federal health-care plans at risk of unwittingly carrying and spreading the deadly virus.

In 2006, the Centers for Disease Control and Prevention called for routine testing of all teen and adult Americans up to age 65 to find 250,000 people who might be unaware they're infected. Payment for such screening, though, isn't offered under the health plan for 8.5 million federal employees or Medicare, which covers 7.1 million disabled people under age 65.

Ignoring the guidelines allows HIV to spread and keeps those infected from early diagnosis and therapy, which can extend the lives of HIV patients, said Bernard Branson, a CDC testing expert. Activists set to attend next week's international AIDS meeting are awaiting new government data that they say may show a 50 percent rise in annual U.S. infections.

``It's a real paradox when one big federal agency makes a recommendation that another big federal agency won't support,'' said John Bartlett, a Johns Hopkins University AIDS doctor who has found that Medicare won't pay for routine screening of patients at his hospital. ``I think they've got to catch up. It's a disease that's lethal, and one of the major problems with HIV today is late entry into care.''

The CDC is the U.S. agency responsible for protecting the nation's health by tracking disease outbreaks and setting public health standards. Private insurers, led by Minnetonka, Minnesota-based UnitedHealth Group Inc., Aetna Inc. in Hartford, Connecticut, and Cigna Corp. of Philadelphia, began covering routine testing soon after the guidelines were announced.

33 Million Worldwide

About 33 million people have contracted AIDS worldwide. The human immunodeficiency virus, or HIV, causes acquired immune deficiency syndrome, which weakens the body's ability to protect itself from infections and some cancers. People catch the disease from infected blood or semen and, in the U.S., gay men and injectable drug users are considered at highest risk.

Previous to the guidelines, the CDC only recommended testing people at high risk, along with those suffering symptoms that suggested they might have the disease. The agency rejected that philosophy in 2006, along with consent and counseling recommendations designed to protect patients, saying it endangered public health.

The CDC changed its recommendations because risk-based screening frequently wasn't covered by insurance, and doctors often didn't know which of their patients were at highest risk. Also, more people outside the standard risk groups, including women, minorities, and people living outside cities, were becoming infected, according to comments accompanying the guidelines.

`Effectiveness Diminished'

``The effectiveness of using risk-based testing to identify HIV-infected persons has diminished,'' HIV experts, led by the CDC's Branson, wrote when the guidelines were put in place.

The $35-billion-a-year Federal Employees Health Benefit Plan pays 230 regional health plans nationwide to care for U.S. workers -- including at the CDC -- elected officials such as those in Congress, and their family members.

Instead of the CDC's guidelines, the federal plan follows an alternative protocol adopted by the U.S. Preventive Services Task Force, which only covers testing for high-risk individuals.

To support screening recommendations, the task force requires that studies have already demonstrated the testing offers benefit for patients, said Ned Calonge, chair of the advisory panel. While the CDC's guidelines are aimed at identifying more undiagnosed patients, they haven't yet proved that they'll be successful, he said.

`Indications to be Optimistic'

``I don't think they have evidence that a universal testing strategy is going to lead to lower infection rates and less HIV,'' he said in a telephone interview from the Colorado Department of Public Health and Environment, where he is chief medical officer. ``There are some indications to be optimistic, but optimism and promise aren't proof.''

The CDC's Branson disagrees. Meeting the task force's requirements for proof might take years, during which lives would be lost, Branson said. The CDC recommended universal testing for pregnant women in 1995, and the task force didn't follow suit until 10 years later, during which studies showed the screening saved thousands of babies from catching the deadly disease, he said.

Another reason to support routine testing, CDC research has found, is that as many as 70 percent of new HIV cases every year are spread through the blood or semen of people who don't know they're infected, Branson said. Many haven't suffered symptoms and don't think they're putting other people at risk by having unprotected sex, he said.

Black Population

Medicare, the U.S. health program for the elderly and disabled, also doesn't cover routine screening for HIV, a spokesman said. While most recipients are older than CDC's cutoff point of 65 years, about 7 million younger disabled recipients should be screened, according to CDC's guidelines.

Risk-based testing imperils thousands of people with HIV, particularly among the U.S. black population where about 2 percent are infected, said Cornelius Baker, policy adviser at the National Black Gay Men's Advocacy Coalition in Washington.

Many physicians don't ask patients about sexual behavior, and make assumptions about who may be at risk of infection, Baker said. Black people who may not consider themselves at risk won't be tested unless offered routine screening, he said.

``Some doctors are still making irrational decisions about HIV testing, deciding whether to screen someone based on what he or she looks like,'' Baker said in a July 21 telephone interview. ``I can't imagine any African American not being screened for sickle-cell disease; why not for HIV, which is higher in prevalence?''

Forty-three states and the District of Columbia require all newborns to be tested for sickle-cell disease, a blood disorder, according to the Sickle Cell Disease Association of America in Washington.

Blacks represent 13 percent of the total U.S. population, and account for about half of all AIDS virus infections in men and women, according to the CDC. Infection rates are 10 times higher among blacks than whites in the U.S., CDC said.

To contact the reporter on this story: John Lauerman in Boston at jlauerman@bloomberg.net; Avram Goldstein in Washington at agoldstein1@bloomberg.net.

Last Updated: July 31, 2008 00:00 EDT