Emergency room patients who are most at risk for HIV are opting out of HIV testing at a huge rate amid a hospital atmosphere cold to such testing. Hospital personnel view it as too time-consuming, and insurers are reluctant to reimburse hospitals for their test-related expenses. In 2006, the Centers for Disease Control and Prevention recommended that everyone visiting a hospital for a major disease condition be tested for the virus that causes AIDS, with the opportunity for them to opt out of the testing, if they so chose.

Since then, only about 5 percent of such patients have been tested, according to Veronica Miller, director of the Forum for Collaborative HIV Research, an independent public-private partnership operating at the George Washington University School of Public Health and Health Services.

“HIV is a life-threatening disease that is so grossly underdiagnosed and undertreated in this country,” Miller said in a briefing on the two-day Summit on HIV Testing. It’s been found that infection rates in urban emergency rooms are from 0.5 percent to 1 percent of those tested – though many refuse testing, which involves a simple saliva test followed, if necessary, by a confirmatory blood test, all of which cost $80 to $120.

In Washington, D.C., where it’s estimated that 5 percent of people are infected with HIV, the George Washington University Medical Center emergency department found that only 0.8 percent of people tested were HIV positive. But half of those in the city’s wealthiest ward chose not to be tested, as did a third of people in the poorest ward. So it’s probably the case that the HIV rate is sharply higher among those who refuse the test.

A study done at Hahnemann University Hospital in Philadelphia found that patients’ acceptance of testing was boosted to 83 percent when trained counselors spent just five minutes pitching each emergency room patient. Such an increase could greatly benefit those who are HIV positive by catching the infection at an early stage, when it’s more treatable.