The stance, announced Thursday, marks a shift from the earlier official position of recommending testing only for people considered at high risk of the disease, such as intravenous drug users and those with multiple sex partners.
The move was spurred largely by the recent arrival of a 20-minute HIV test that disease officials believe can be used to reach people at the margins of the nation's health-care system.
The federal government also is calling on states to conduct HIV testing on newborns whose mothers have refused to get tested. Testing for the disease in women and babies will be voluntary at the federal level, though officials left open the possibility that states could impose mandatory screening of infants. An estimated 300 American babies contract HIV from their mothers each year.
The U.S. Centers for Disease Control and Prevention says the recommendations are part of a campaign to drive down the number of new HIV cases, and to identify the 200,000 Americans who have the virus but don't know it.
"It's tragic and really unacceptable that 200,000 people in this country don't know their HIV status," says CDC director Dr. Julie Gerberding. As many as 950,000 Americans now have HIV, and that number grows by 40,000 every year.
The 20-minute HIV test, called OraQuick, that can be administered in places like community clinics, women's shelters, prisons and other settings. That's key, Gerberding says, because many low-income and minority women lack adequate prenatal care, and thus don't have access to the conventional medical system.
"We want to eliminate access to the medical system as a barrier" to getting tested for HIV, Gerberding says. The quick test "is a huge technological advance that has profound implications, we hope, for the undiagnosed people."
Testing pregnant women is crucial, Gerberding adds, because antiviral drugs can block the spread of HIV from an infected woman to her baby. Under the new guidelines, women can "opt out" of screening if they don't want the test. Anyone who tests positive for the virus will be encouraged to seek counseling and treatment to control the infection.
In addition to focusing on women and infants, the CDC also wants doctors to make HIV screening "a part of routine medical care" for people living in areas where HIV is common, and among those in low prevalence areas but at high risk of infection. The agency also will be encouraging doctors to work with people with HIV and their sex partners to reduce the transmission of the virus, according to the April 18 issue of its Morbidity and Mortality Weekly Report.
"We can no longer accept the status quo when it comes to HIV/AIDS prevention," Health and Human Services Secretary Tommy G. Thompson said in a prepared statement. "The nature of this epidemic is changing, and it is time to expand our prevention strategies in order to more effectively reduce the number of HIV infections in the United States."
Dr. Laura Riley, an obstetrician at Harvard Medical School in Boston, and a spokeswoman for the American College of Obstetricians and Gynecologists, says the new speedy HIV test is especially valuable for women who arrive at labor and delivery wards after a pregnancy without prenatal care.
"At that point you can do a rapid test and, if it's positive, give [antiviral] drugs" to prevent the woman from infecting her baby. These drugs cut the risk of mother-infant transmission to near zero. About one-quarter of babies become infected if an HIV-positive woman doesn't receive the drugs, Riley says.
The obstetrics group has long recommended that HIV screening be routine during pregnancy, just as doctors test for hepatitis B, syphilis and other infections.