But barriers stand in the way of this recommendation, made Thursday by the U.S. Centers for Disease Control and Prevention.

Some doctors are reluctant to automatically include a test for the deadly AIDS virus in routine exams.

They worry about notification procedures and counseling if test results are positive. Patients may not want the test, either because they dismiss the risks or worry about costs.

But the CDC projected great benefits in issuing its unprecedented guidelines that, though not mandatory, are bound to influence doctors, clinics, hospitals and insurers.

About 1 million people across the country are living with HIV, and the CDC estimates more than a quarter-million others are unaware they have the disease. In 2004, there were about 5,800 HIV cases in Arizona. Early treatment could greatly improve care.

The CDC, which up to now has emphasized testing of high-risk groups, wants doctors to set up the HIV screening as an opt-out situation, testing patients for HIV in routine blood panels unless the patient requests omission.

Some patients likely will.

"I'm married 30-plus years, have never taken drugs, I'm not in a high-risk group therefore I'll pass on this test," said 53-year-old Joe Hutchinson of Glendale.

Other people would have no problem with the regular tests.

"It certainly couldn't hurt if there was even the remotest chance that a person could be infected," said Cave Creek resident Marty Goodwin, 59.

"Stopping the spread of this awful plague needs to start somewhere, and if ordinary citizens could help by being tested, I don't see why not."

The stigma issue

About half of those with HIV learn they have the disease after it is at an advanced stage. HIV remains a leading cause of illness and death in the country.

As of December 2004, an estimated 944,306 people had received an AIDS diagnosis. Of those, 56 percent had died.

The number of AIDS cases and deaths stabilized between 1999 and 2004 but since 1994, the annual number of cases among Blacks, members of other racial/ethnic minority populations, and persons exposed through heterosexual contact has increased.

The human toll remains high, despite new combinations of drugs fighting the disease.

But HIV tests also still carry a stigma.

"Many patients will be hurt or angry if this is brought up to them as a requirement," said Dr. Jacqueline Chadwick, a family physician in the Valley. "They would perceive it as a question of their lifestyle."

The HIV test should be an opt-in rather than opt-out situation, said Chadwick, an associate dean of clinical affairs at the University of Arizona College of Medicine Phoenix Campus.

She said she doesn't hesitate to discuss issues like HIV with her patients. But she doesn't think everyone needs to be tested.

Anne Maley, executive director of the Southern Arizona AIDS Foundation in Tucson, said doctors shouldn't hesitate to ask for this test, and the CDC should be applauded for its recommendation.

Maley, whose organization, which serves about 1,200 people with HIV, said testing should be more accessible.

"We need this sense of globally testing," she said. "That's how we remove the stigma."

Government health officials are optimistic the recommendations will motivate both doctors and patients to have the test.

The outcome could be that as HIV tests become more prevalent, any negative connotation attached to the screening would diminish.

"Public health officials around the country continue to try to normalize the way we think about HIV and HIV testing," said Bob England, acting director of the Maricopa County Health Department.

"We want this to be a test that isn't so special you have to go to some special place. It's something you can get in a health provider's office."

England hopes doctors will be willing to suggest the test, but if they don't, patients should speak up.

Yet he knows the stigma isn't so easily erased.

"This is about sex, after all, and that's always a hard topic to bring up. Health care providers are human, too, but we need to get past that."

The CDC recommends screening be built into the general consent form as part of medical care, not in a separate written consent. In addition, prevention counseling would not be required as in past HIV diagnostic tests.

But some AIDS organizations worry that a lack of counseling will lead to confusion and more worry about results.

Cost of testing

Aetnasaid it will follow the CDC recommendation and cover all HIV testing, said Rachelle Cunningham, west region public relations manager for the health-care company. Previously, the firm covered tests for high-risk patients.

HIV tests for all patients have been part of their coverage based on a doctor's recommendation, said Regena Frieden, director of public relations for Blue Cross Blue Shield of Arizona.

But the cost for HIV involves more than just the $15 test itself, doctors say.

There are the added costs for longer doctor visits to discuss the test.

No one should just lightly perform the HIV tests, said M. Zuhdi Jasser, president of the Arizona Medical Association. They aren't as simple as testing for cholesterol.

"Certainly HIV testing is a screening test that all of us would support in being done, but I do have some concerns," Jasser said.

HIV testing involves prolonged discussions with a patient before and after a test, he said. Will doctors be reimbursed for the extra time?

In addition, he worries about false positives, which could bring emotional trauma to someone who wouldn't otherwise be tested.

More HIV tests, and a higher number of positive results, also will challenge state health care officials.

Once someone is identified, the aim is to find his or her partners.

It's not something that can be coerced from someone.

"It's delicate work," England said.

"Often people are embarrassed and they're worried about themselves and their partners. We can be very helpful in doing the notification."

He said he isn't sure who will pay for the extra work.