artner Counseling and Referral Services for HIV nfection

t H s N b b n w r t o t e d e t 5 h o p r nowledge of HIV serostatus is valuable for personal as well as public health. Individuals testing HIV-positive can access antiretroviral herapy, which increases quality of life and survival. eduction of viral load to undetectable levels reduces, lthough does not eliminate, infectiousness and risk of ransmission. In addition, individuals aware of their nfection have substantially lower levels of high-risk ehavior than those not aware of their infection. Available evidence indicates that a substantial proortion of HIV-infected individuals are not aware of heir infection. Although approximately 20,000,000 IV tests are performed in the United States each year, 5% (252,000–312,000) of the estimated 1.0–1.2 milion HIV-infected people living in the U.S. are not ware of their infection. In some subgroups, this roportion is likely much higher; for example, a study f men who have sex with men in five U.S. cities found hat as many as 77% of those testing HIV positive were ot aware of their infection. Even among those who re aware, recognition often comes late in the course of heir infection. From 1990 to 1992, the proportion of eople who first tested HIV positive less than 1 year efore being diagnosed with AIDS was 51%; in 2004, his proportion was 39%. Many of the new HIV infections occurring in the U.S. ach year are likely attributable to infected individuals ot aware of their infection. A recent analysis suggests hat the transmission rate among those not aware is pproximately 3.5 times higher than the rate among hose who are aware of their infection (accounting for etween 54% and 70% of new infections). Clearly, eaching and diagnosing HIV-infected individuals and inking them to effective medical care and prevention ervices—and doing so as early after infection as ossible—is important for improving their own health s well as reducing HIV transmission and is a major hallenge for the HIV-prevention community. If 75% of those infected are aware of their infection, ow can we reach the other 25%? There are emerging