摘要：Despite increasing discussion about the dental care setting as a logical, potentially fruitful venue for rapid HIV testing, dentists’ willingness to take on this task is unclear. Semistructured interviews with 40 private practice dentists revealed their principal concerns regarding offering patients HIV testing were false results, offending patients, viewing HIV testing as outside the scope of licensure, anticipating low patient acceptance of HIV testing in a dental setting, expecting inadequate reimbursement, and potential negative impact on the practice. Dentists were typically not concerned about transmission risks, staff opposition to testing, or making referrals for follow-up after a positive result. A larger cultural change may be required to engage dentists more actively in primary prevention and population-based HIV screening. An estimated one fifth of Americans infected with HIV, approximately 250 000 individuals, are unaware of their status. 1 Consequently, individuals are often diagnosed only when their disease has progressed and they are symptomatic 2 or they already have AIDS. The advent of the rapid HIV test has made it possible to offer HIV testing in a much wider array of settings, thus creating the opportunity for more infected individuals to be identified earlier. Paltiel et al. 3 estimated that widespread routine HIV screening would extend survival by 1.5 years for the average detected HIV-infected individual who enters care. Furthermore, studies have also shown that most persons who learn that they are HIV positive reduce sexual risk behaviors, resulting in reduced transmission to others. 4–6 The rapid HIV test is a fast, reliable, simple, and cost-effective method to screen for HIV, 7–11 yielding results typically in 20 minutes or less and relieving burdens on both patients and providers that arise from the need for tested persons to return later to obtain results. Although it is a screening test, and therefore a reactive-positive result must be confirmed with traditional testing, it has been shown to be comparable to the traditional Western blot in sensitivity and specificity. 11 The Food and Drug Administration approved the rapid HIV test using whole blood from a finger stick in 2002 12 and using oral fluid in 2004. 13 Rapid testing is now the preferred method for many providers and clients. Oral fluid collection for testing has demonstrated high acceptability in preliminary studies with various risk groups. 14–18 Given the availability of a safe, reliable, and acceptable rapid test for HIV, and recognizing the value for both individuals and public health of identifying undiagnosed cases of HIV infection as early as possible, in 2006 the Centers for Disease Control and Prevention issued revised recommendations for HIV testing. 19 In the recommendations, they advocated that all individuals aged 13 to 64 years be routinely tested in all private and public health care settings and that HIV testing be included among the routine prenatal tests pregnant women take.
