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WASHINGTON — Two years after the government urged making HIV tests as common as cholesterol checks, there have been small gains, but still one person in five infected with the AIDS virus doesn't know it, scientists said Thursday.

Eleven states that once required special consent for HIV testing have changed their laws, a key step to making an HIV test part of the standard battery that patients expect.

But HIV specialists meeting Thursday said other barriers include physician confusion about the ease of today's rapid tests, which can cost as little as $15 — although many patients seem to accept them.

No more than 100 of the nation's 5,000 emergency rooms routinely test for HIV in patients who aren't critically ill, said Dr. John Bartlett of Johns Hopkins University, who co-chaired the Forum for Collaborative HIV Research meeting. Yet because so many HIV patients are poor or uninsured, ERs are the health-care setting most likely to find them.

And while every pregnant woman is supposed to be tested so steps can be taken to protect her baby, about 40 percent aren't, he added.

"Those are what we call missed opportunities," Bartlett said.

Just over 1.1 million Americans are estimated to have HIV, and 232,000 don't know it, according to the Centers for Disease Control and Prevention.

Though modern drugs are potent enough to keep HIV patients healthy for years, postponing the slide into full-blown AIDS, nearly half of new infections still are being discovered too late for patients to benefit. And people who don't know they're infected can unwittingly spread the virus.

In September 2006, the CDC recommended routine testing for everyone 13 to 64, regardless of the patient's opinion on his or her risk.