A government-backed panel of medical experts says everyone between the ages of 15 and 65 in the United States should be tested at least once in their lives for HIV, a policy that Stanford’s Douglas K. Owens says could have a substantial impact on the course of the epidemic.

Owens, a professor of medicine and director of Stanford Health Policy at the university’s Freeman Spogli Institute for International Studies, is a member of the U.S. Preventive Services Task Force, which issued its draft recommendation on Nov. 19.

Currently, there are an estimated 1.2 million people in the nation infected with HIV, and some 20 to 25 percent of them aren’t aware they carry the virus that causes AIDS. If they were diagnosed, they could get into treatment programs, which would benefit them as well as helping to prevent the spread of the disease.

“We think it’s important for everyone to be screened once because treatment helps people live longer, healthier lives and also prevents transmission to others,” said Owens, who is also a senior investigator at the Veterans Affairs Palo Alto Health Care System.

Those at very high risk, including gay men and injection drug users, should be tested every year, while others considered at increased risk also should undergo repeat testing with the frequency depending on risk, the task force recommends. In addition, the panel said practitioners should screen all pregnant women for the virus; the practice, now common in this country, has helped virtually eliminate the incidence of mother-to-child transmission, Owens noted.

In 2005, the task force strongly recommended HIV screening in adolescents and adults considered at increased risk for HIV, but it stopped short of recommending a universal testing program.  The new recommendation for widespread screening reflects the changing world of AIDS science, Owens said.

For instance, studies have shown that an early diagnosis — even before symptoms begin to emerge — followed by effective antiretroviral treatment, can help prevent individuals from developing life-threatening complications. Moreover, HIV-infected individuals who are treated with antiretroviral drugs are much less likely to pass on the virus to others. A landmark study published in August 2011 and involving 1,763 heterosexual couples (in which one was HIV-positive and the other was not) found that treating the infected partner reduced his or her chance of transmitting the virus by 96 percent.

In addition, once people are diagnosed, they can be counseled about changing their behaviors to help prevent the spread of the disease. Observational studies have shown that people who know their HIV status are more likely to take precautions, for instance, by using condoms, avoiding sex with sex workers or having sex in exchange for money or drugs, the task force noted.

In 2006, the federal Centers for Disease Control recommended routine voluntary screening for everyone aged 13 to 64, but allowed them to opt out of testing. Many other professional groups, such as the American College of Physicians, also advise routine patient screening. Yet universal screening, followed by treatment, has never been achieved in this country.

Owens said the task force did consider the potential harms of screening and testing. One potential drawback is a false-positive test result, though the screening test is highly accurate, so this risk is quite small, he said. Treatment also may carry side effects, including the possibility of a slightly increased risk for heart problems. Stigmatization and labeling are other potential downsides of testing, he said.

But on balance, he said, “We feel the benefits are so substantial that they far outweigh the potential harm.”

He said the task force also emphasized the importance of prevention: “The best way to reduce HIV disease and death is to avoid becoming infected. So we want people to take actions to reduce their risk behaviors, such as using safe sex practices and avoiding other behaviors that put them at risk.”

The task force’s draft recommendation has been posted for public comment on its website at http://www.uspreventiveservicestaskforce.org. Comments can be submitted from Nov. 20 to Dec. 17 at www.uspreventiveservicestaskforce.org/tfcomment.htm. The panel then will finalize its recommendations, which will be published in the Annals of Internal Medicine.

Ruthann Richter is the director of media relations at the Stanford School of Medicine.

Fresh off his re-election victory, Barack Obama—the “Pacific President”—became the first president to visit Myanmar and Cambodia when he traveled to the Southeast Asian countries in November.

The trip highlights the region’s importance to the United States and signals that Obama’s second term will significantly focus on Asian trade, security and governance issues.

Eight Walter H. Shorenstein Asia-Pacific Research Center scholars sat down to discuss reactions to the election in Asia, and possible directions for U.S.-Asia relations and foreign policy during the second Obama administration.

How do you think countries in Asia view the outcome of the U.S. presidential election?

Karl Eikenberry: Overall, I think the countries of Asia will view President Obama’s reelection as positive, including because of the likely continuity in American policy toward the region.

Thomas Fingar: Beijing is troubled by Obama’s policies toward Asia because it sees them as directed against China and detrimental to its interests. But it was more troubled by Romney’s rhetoric during the campaign and probably interprets the election outcome as portending more continuity than change in U.S. policy. On balance, Beijing would rather deal with a devil it knows than cope with the uncertainties of a new U.S. administration.

Gi-Wook Shin: There was some concern in South Korea that Mitt Romney would have reverted to the hardline North Korea policy of George W. Bush’s first term. It would have created a bit of tension between the United States and South Korea, so in that context many Koreans are relieved that Obama was re-elected.

David Straub: Interestingly, President Obama personally is overwhelmingly popular in South Korea, but opinion polls show that most South Koreans continue to have complex, even critical views of American foreign policy under him.

Is President Obama likely to make major changes to Asia policy in his second term?

Eikenberry: Some of the people in key positions in the second Obama administration will change, including Secretary of State Hillary Clinton, but President Obama will of course be in office for four more years. He has been in Asia and knows the players. He has a clear strategy, so overall I expect continuity in his administration’s Asia policy. 

Michael H. Armacost: Events are really what shape foreign policy, and developments can occur that are hard to predict.

Henry S. Rowen: We tend to assume there is a continuity or gradual evolution to events, but there are also discontinuities. Something could happen in North Korea, for example. Unexpected events do happen from time to time, and the question is to try to figure out what they might be.

How could U.S. China policy develop?

Fingar: If President Obama has a clear plan for his second term, its goals and priorities are not yet clear to the Chinese. They worry that he may continue, or ratchet up, efforts they see as designed to constrain China’s rise. That said, they know that steady relations with the United States are essential for their own continued economic success and will respond positively to U.S. efforts to reduce distrust and enhance strategic stability. They will be troubled, however, by likely—and overdue—U.S. pressure to secure enforcement of China’s intellectual property and other trade-related commitments, and by likely U.S. efforts to deepen trade relations with other countries.

How could the possible election of a more conservative Japanese government during the second term of the Obama administration affect U.S.-Japan relations?

Armacost: The Trans-Pacific Partnership is an issue where we both have potential constraints on the extent to which Japan can be included, and it is not certain whether that will change very much under a Liberal Democratic Party (LDP) administration. Secondly, there is the longstanding Okinawa base issue. The LDP did not do anything about the base from 1996 onward, and that will probably also be the case if the LDP comes into power again. Finally, the United States will probably push Japan to take more of a stand on the ongoing Senkaku/Diaoyu Islands dispute with China.

After the failure of the United States’ Leap Day agreement with North Korea this year, and especially with the election of a new South Korean government next month, do you think that Obama’s second term could bring a renewed effort in diplomacy with North Korea?

Shin: It will be important to watch the outcome of the South Korean election. If the opposition party wins, they will move very quickly to engage with North Korea and the question then will be how the United States will respond.

Straub: In any event, the United States periodically reaches out to North Korea, to test it or just because time has passed. It may do so again after the election, particularly since there is a still fairly new leadership in North Korea, and also because there are elections or leadership changes in all the countries in the region. A number of the Six Party Talks member states, likely including South Korea, may also push harder for a resumption of those talks, which were never held during President Obama’s first term. But the Obama administration will be cautious because it was burned by North Korea’s breaking of their Leap Day agreement.

What direction might U.S. policy toward South Asia take?

Eikenberry: Our presence in Afghanistan is going to remain an important part of our overall military posture in Central, South, and East Asia. Managing properly the transition to full Afghan responsibility for their internal security will remain very high on President Obama’s agenda. At the same time, it will be important to keep some U.S. counterterrorism capability in Afghanistan, with the permission of the Afghan government.  

The nature of our security dialogue with Pakistan will change in emphasis from one that since 9/11 has mostly been informed by international terrorism. If we continue to make progress against Al Qaida, I expect our conversation with Pakistan will place more emphasis on its nuclear weapons programs and deployments. This is a potentially destabilizing issue and a concern not only to India, but also to China.

There has been a steady appreciation in the current and future importance of India. It will continue to be key in terms of the administration’s broader Asia-Pacific policy, but with a clear understanding of the limits of defense engagement with India.

Will the rebalancing, or “pivot,” toward Asia continue to be a central theme in U.S. foreign policy in Obama’s second term?

Eikenberry: Last year, when President Obama announced the rebalancing to Asia, I think this was done in part to signal to the world that we were putting the decade of costly wars in Iraq and Afghanistan behind us and looking forward—that the U.S. “was back.” I do not believe we will see any short-term major change in the deployment of military capabilities to the Asia-Pacific region, but the rebalancing could have profound consequences in the longer term. It will likely inform the prioritization of our future defense modernization and the development of military doctrine, which in turn drives procurement.

Donald K. Emmerson: Asia will continue to loom large on Washington's policy horizon. Although the pivot was originally all about security, the rebalance has since been "rebalanced" to encompass economic concerns. In July 2012 when Secretary Clinton went to Phnom Penh to attend the security-focused ASEAN Regional Forum, she brought along the largest delegation of American businesspeople ever to visit Southeast Asia. Their presence upgraded the profile of the U.S.-ASEAN Business Forum, which met the following day. The Obama administration has also taken the lead in promoting a Trans-Pacific Partnership to liberalize Asia-Pacific trade. 

President Obama's mid-November trip to Southeast Asia is further evidence of the pivot's continuation. In mid-November he will become the first U.S. president ever to have visited Myanmar and Cambodia. He will stop in Thailand as well. In Phnom Penh he will attend the U.S.-ASEAN Summit and the East Asia Summit. A key issue at these meetings will be the quarrels over sovereignty in the South China Sea between China, Taiwan, the Philippines, Vietnam, Malaysia, and Brunei. To the extent that the United States appears to be intervening against Beijing in these disputes, the "pivot" will be interpreted as a move to check China.

Armacost: There is no doubt that the Asia rebalancing strategy will endure, but the components and the apportionment of resources may change. President Obama may have initially overplayed engagement with China, and now he is probably hedging too much. But it does not change the fact that there is a lot at stake in terms of our relationship with China and that we have to engage the government. So it is a question then of where to strike a balance between hedging and engagement. After the election, there is also the question now of what happens to U.S. trade policy, and whether the Trans-Pacific Partnership will include India, China, and Japan.

Daniel C. Sneider: If you look at the president’s broader message and the one he carried in the campaign, he is very focused on restructuring and moving toward a more innovation-centered U.S. economy to develop new sources of employment. In addition to being concerned about climate change, he is also seriously looking at alternative energy resources as a source of real growth in the U.S. economy and as a way to move away from foreign fossil fuel dependency. Focusing more on the Asia-Pacific region is also quite consistent with these goals.

As the East Coast cleans up from super-storm Sandy, Phillip Lipscy and Kenji E. Kushida point to important lessons from Japan's Fukushima nuclear disaster. They say more must be done to safeguard U.S. nuclear plants from natural disasters.