Reposted from the old TfK.
Both essentially argue for the broadening of HIV testing in American society. The NEJM piece largely recycles the history of debates about testing for HIV in the general population, and state limitations on what testing can be mandated. Tara explains:
Currently, the testing paradigm in most areas is patient-instituted, and involves the three C’s: consent, confidentiality, and counseling (generally before and after the test). If HIV testing were increased, a concern is that the quality of counseling could decrease, due to the lesser availability of trained professionals to discuss the implications of the test with patients. This could leave individuals whose test came back positive for HIV floundering, unsure what to do next, how to receive treatment or protect their loved ones from infection (or discuss that possibility with them), and unversed in dealing with the stigma that may follow a diagnosis of infection with HIV.
For these reasons, it’s unlikely that any kind of universal testing will occur anytime soon.
When it was found that prenatal treatment with anti-retrovirals could decrease the chance of mother to child transmission, some states instituted mandatory pre-natal screening, but even that didn’t spread. The stigma of HIV/AIDS is too great, and before the disease could be controlled effectively the testing was too close to a death sentence to make it mandatory.