A Skeptic Looks at “Test and Treat”

All wars inevitably breed profound differences of opinion between the generals in the war rooms and the soldiers in the field. Wars against disease are no exception. Elegant theoretical strategies, whether they involve guns or pills, may seem remarkably misguided to those serving close to the action.

It seems to me that the enthusiasm for a “test and treat” strategy to combat HIV is, at least for American patients, one of these instances. This strategy, which calls for universal voluntary HIV testing and immediate antiretroviral therapy (ART) for all who test positive, has been widely hailed as a breakthrough in the fight against AIDS.1 I think it would be a big mistake.

Many decades of hands-on experience with HIV-infected patients has certa…