HIV testing for Everyone

[freethefly 6]

This should had been standard some years back. I hope that all countries follow in suit.

CDC wants HIV tests for everyone
Tuesday, May 9, 2006; Posted: 9:27 a.m. EDT (13:27 GMT)

Centers for Disease Control & Prevention
AIDS (Disease)
Health Treatment
ATLANTA, Georgia (AP) -- Testing for the AIDS virus could become part of routine physical exams for adults and teens if doctors follow new U.S. guidelines expected to be issued by this summer.

Federal health officials say they would like HIV testing to be as common as a cholesterol check.

The guidelines for routine testing would apply to every American ages 13 to 64, according to the proposed plan by the U.S. Centers for Disease control and Prevention.

One-quarter of the 1 million Americans with the AIDS virus don't know they are infected, and that group is most responsible for HIV's spread, CDC officials said.

"We need to expand access to HIV testing dramatically by making it a routine part of medical care," said the agency's Dr. Kevin Fenton.

CDC officials presented the plans at a scientific conference in February. Last week, they said the guidelines should be released in June or July.

The recommendations are not legally binding, but they influence what doctors do and what health insurance programs cover.

Currently, the CDC recommends routine testing for those at high-risk for catching the virus, such as IV drug users and gay men, and for hospitals and certain other institutions serving areas where HIV is common. It also recommends testing for all pregnant women.

Under the new guidelines, patients would be tested for HIV as part of a standard battery of tests they receive when they go for urgent or emergency care, or even during a routine physical.

Patients would not get tested every year: Repeated, annual testing would only be recommended for those at high-risk.

There would be no consent form specifically for the HIV test; it would be covered in a clinic or hospital's standard care consent form. Patients would be allowed to decline the testing.

Standardizing HIV testing should reduce the stigma as well as transmission, CDC officials said. Nearly half of new HIV infections are discovered when doctors are trying to diagnose an illness in a patient who has come for care, they noted.

The American Medical Association supports the proposed recommendations, said Dr. Nancy Nielsen, a Buffalo, New York-based physician who is speaker of the AMA's House of Delegates.

Some doctor's offices will face challenges implementing the recommendations, she added. For example, they should not give a positive HIV test result over the phone and would have to provide or arrange for counseling.

But the benefits of reducing the spread of HIV far outweigh the logistical challenges, said Nielsen, an infectious disease specialist.

"I'm so happy the CDC is recommending this," she said. "HIV is an infectious disease and it should be treated like any other infectious disease. The fact that it has been treated so differently, I think, in some ways has contributed to the stigma."

Some patients' advocates have voiced concern that the recommendations do not include pre-test counseling and sufficient informed consent.

At many HIV testing sites, patients sit through a counseling session to explain the procedure before any blood is drawn. Many centers also require a patient to give "informed consent," indicating they understand the risks and benefits of the test.

The proposed recommendations do not require pre-test counseling in medical settings. They call for post-test counseling to be offered only to patients who test positive.

Pre-test counseling and informed consent ensure that patients are warned of possible mistakes in test results, said Catherine Christeller, executive director of the Chicago Women's AIDS Project.

They also can explain the implications of HIV testing, she added. For example, undocumented workers who test positive for the AIDS virus may be deported and need to understand that, Christeller said.

CDC officials say they understand advocates' concerns and are optimistic physicians will follow the recommendations carefully.

"Doctors should be explicit that 'You're going to be tested,"' said Dr. Tim Mastro, acting director of the CDC's division of HIV/AIDS prevention.

"...And once you're gone, you can't come back
When you're out of the blue and into the black."
Neil Young

[kelpdiver 2]

Quote

There would be no consent form specifically for the HIV test; it would be covered in a clinic or hospital's standard care consent form. Patients would be allowed to decline the testing.

Standardizing HIV testing should reduce the stigma as well as transmission, CDC officials said. Nearly half of new HIV infections are discovered when doctors are trying to diagnose an illness in a patient who has come for care, they noted.

This is going to be resisted, and with good reason. HIV status will continue to have a severe stigma attached, and the combination of data mining and sloppy records handling makes it foolish to do HIV testing that isn't anonymous. It wasn't that long ago that people still proposed concentration camps for HIV+ people.

As it is, refusing to allow the test will likely also have consequences in terms of insurability. It's a good step for progress on the health issues, but terrible on the rest.

[freethefly 6]

I don't see why anyone would have a legitimate reason to resist the test. As is stated, "Patients would be allowed to decline the testing". I believe that knowing your status should take precedence over all else. You would think that after 25 years of an epidemic that has taken so many and has disrupted the lives of so many that people would disconnect the stigma. I originally worried about what people would think if they knew I was poz. Well, no time to worry about what others think when it is your life on the line. But, you know, as it is HIV is the most unique illness in terms as to how it is viewed by the general population. Most believe that it will never enter their lives. I was the same as I was not in the risk groups. I have met several who also were not in the high risk groups. Heterosexuals are amongst the highest number of newly infected. Transmission amongst this group is contributed to promiscuity amongst single and married people (cheating spouses, open relationships) more so than intreveneous drug use amongst the same group. As with any type of illness, testing for such should be vigorously encouraged.

"...And once you're gone, you can't come back
When you're out of the blue and into the black."
Neil Young

[kelpdiver 2]

Quote

I don't see why anyone would have a legitimate reason to resist the test. As is stated, "Patients would be allowed to decline the testing".

My first paragraph addressed your first sentence. My second your second.

[UntamedDOG 0]

Quote

I don't see why anyone would have a legitimate reason to resist the test.

Dealing with AIDS is an emotionally and financially crippling ordeal.

In some cases, it is simply better to not be aware that you are infected.

With our current health care system, many people simply cannot afford the treatment, why should they deal with a disease they can do nothing about?

Ignorance is bliss.

Use a condom.

[FrflyPimpDaddy 0]

With the attitude you all are taking, remind me not to ever have sex again with anyone (but especially you).

Get tested, damnit! You can't ignore the big pink elephant in the corner. How stubborn and ignorant are you going to be?

[SpeedRacer 1]

they already screen your blood for HIV whenever you donate.

Speed Racer
--------------------------------------------------

[beowulf 1]

BULLSHIT

they can sure as hell not spread it. If you don't know you have AIDS then you don't know that you are spreading it around. Even if you wear a condom your partner at the least deserves to know what risk he or she is taking.

[Beverly 1]

Some info:

America has billions of people and about 1.2 million people infected.
SADC (Very southern region of Africa including 4 countries) has around 60 million people and 25 million people infected. So I know a little about the disease.

In South Africa, you get additional points on your medical insurance if you are tested annually.
I get tested when I visit my GP for my annual Cholestrol, blood pressure and pap smear test.
Having been sexually active or not over that year.

Ignorance is the main cause of the disease spreading and the fact that people are unaware of their status is frightening.

In Africa, we unfortunately have to deal with the stigma attached to a man's virility wrt using a condom as it is seen as manly to procreate.
If a Zulu man does not bear children (Many) he is seen to be inadequate. They also have multiple wives and girlfriends.

The most shocking part was the witchdoctors saying that if you sleep with a virgin it will cure you. So baby rapes became a daily occurence.
But then again how is a nation supposed to learn safe sex when the ex-deputy president says that if you have unprotected sex, you can wash the aids away in the shower...

I have seen work mates and people die of this disease. It is not pretty.

Rather get tested, know your status and encourage others to do the same.

It is for your own good and well being.

I think true friendship is under-rated

Twitter: @Dreamskygirlsa

[narcimund 0]

Quote

America has billions of people

You might know a lot about HIV rates in southern Africa but you could use a refresher in population geography of the northern hemisphere.

The USA does not have "billions of people."

First Class Citizen Twice Over

[lawrocket 3]

We've got problems of privacy in this. There are plenty of people out there who do not want anybody knowing the person's HIV positive status. Testing is effective at letting people know if they are infected. But it has little or nothing to do with informing the afflicted's partners. That's up to the afflicted to provide the names, which is "contact tracing."

My biggest fear is in just how effective this can be when privacy protections for the afflicted have a fairly long history of being protected - of being given more weight than the public concerns to stop the spread.

Much of the effort to do contact tracing has been prevented by activists who claim - probably justifiably - that it would be counterproductive because the desire to get tested would not want their privacy breached.

So, there would likely be some privacy protections in a mandatory testing program. These protections of privacy may have the practical effect of merely identifying a person who is HIV postivie, and then having no way to do anything else with the knowledge.

My wife is hotter than your wife.

[livendive 8]

Quote

So, there would likely be some privacy protections in a mandatory testing program. These protections of privacy may have the practical effect of merely identifying a person who is HIV postivie, and then having no way to do anything else with the knowledge.

Identifying the people who are HIV positive so they know they have an infectious disease seems like a pretty good step to me. Your post makes it sound (to me) like you think that's not a worthwhile goal. Is that really what you were saying?

I'd also like the privacy of the afflicted to be protected. Let them make the decisions on who to tell. We have no right to make those decisions for them.

Blues,
Dave

"I AM A PROFESSIONAL EXTREME ATHLETE!"
(drink Mountain Dew)

[kelpdiver 2]

you really misread what he said. If anything, I read him leaning far on the side of public health versus the privacy side.

You get the most progress in shutting down tranmission rates if you force open testing, demand partners, and follow the trail. But at that level of intrusiveness, people will tend to avoid testing alltogether, fearing the consequences, and society is worse off than it started.

Beverly's posting on how it's done in ZA points out the issues with 'voluntary' standard testing. It really isn't.

[lawrocket 3]

Quote

Quote

So, there would likely be some privacy protections in a mandatory testing program. These protections of privacy may have the practical effect of merely identifying a person who is HIV postivie, and then having no way to do anything else with the knowledge.

Identifying the people who are HIV positive so they know they have an infectious disease seems like a pretty good step to me. Your post makes it sound (to me) like you think that's not a worthwhile goal. Is that really what you were saying?

I'd also like the privacy of the afflicted to be protected. Let them make the decisions on who to tell. We have no right to make those decisions for them.

Blues,
Dave

No doubt it is a good first step. But it's not like providing awareness of breast cancer or prostate cancer. Those are personal issues and the risk of transmitting that to others is none.

When you said, "I'd also like the privacy of the afflicted to be protected. Let them make the decisions on who to tell. We have no right to make those decisions for them." it identifies a fundamental problem - how do we protect public health if knowledge is unavailable to the public? In a sense, there is little to stop the spread of the disease other than the integrity of the afflicted.

There are circumstances where people knowingly infect others. There are far more circumstances where people knowingly expose others to HIV.

How can that be stopped? Education, I'm afraid, won't quite do it...

My wife is hotter than your wife.

[livendive 8]

Quote

No doubt it is a good first step. But it's not like providing awareness of breast cancer or prostate cancer. Those are personal issues and the risk of transmitting that to others is none.

When you said, "I'd also like the privacy of the afflicted to be protected. Let them make the decisions on who to tell. We have no right to make those decisions for them." it identifies a fundamental problem - how do we protect public health if knowledge is unavailable to the public? In a sense, there is little to stop the spread of the disease other than the integrity of the afflicted.

There are circumstances where people knowingly infect others. There are far more circumstances where people knowingly expose others to HIV.

How can that be stopped? Education, I'm afraid, won't quite do it...

What else can we do, tattoo their foreheads? Would we do the same for hepatitis, herpes, influenza, meningitis, or for that matter, all viral infections?

Blues,
Dave

"I AM A PROFESSIONAL EXTREME ATHLETE!"
(drink Mountain Dew)

[billvon 3,077]

>What else can we do, tattoo their foreheads?

How bout this:

Make the information available on a public website for anyone with a specific ID number (say a SS number) and a password. If person A is planning to have sex with person B, then person B can give A his/her password so they can see for themselves. If not, then they are at least warned that the person _might_ have something to hide.

Wouldn't be effective in all cases but might help preserve privacy.

[livendive 8]

Quote

>What else can we do, tattoo their foreheads?

How bout this:

Make the information available on a public website for anyone with a specific ID number (say a SS number) and a password. If person A is planning to have sex with person B, then person B can give A his/her password so they can see for themselves. If not, then they are at least warned that the person _might_ have something to hide.

Wouldn't be effective in all cases but might help preserve privacy.

Wouldn't we get the same benefit out of just educating people, encouraging them to ask that all potential partners show recent hard-copy test results?

Blues,
Dave

"I AM A PROFESSIONAL EXTREME ATHLETE!"
(drink Mountain Dew)

[billvon 3,077]

>Wouldn't we get the same benefit out of just educating people,
> encouraging them to ask that all potential partners show recent
> hard-copy test results?

Perhaps, if such hardcopy test results were routinely given to most people as a result of standardized testing. As it is now, "nope, never got tested cause I'm not gay" is an all-too-common answer.

[lawrocket 3]

We really haven't done the same thing for other diseases. Health officials have routinely contacted partners of those with other venereal diseases since the 1930's. Because of the implications of HIV, this has not been the case for HIV.

My issue is that we may have government spending money on a program that is fundamentally useless until such time as these issues can be resolved. It's good for statistical tracking of a disease, but not necessaruly for prevention, etc.

You also mentioned that we could achieve some benefit from education. Over the last 20 years, we've been educating, and while it certainly has done some good, HIV is still spreading. It's not that people are not educated about it, it's that no amount of education can get many people to think about it once the heat is turned up.

I actually had my test results, and got tested regularly. I've asked to see test results. I got tested with one. The night of fun wasn't worth it to me in the event something bad happened. It turns out that while I could have goten laid more, it was nice to be 30 years old and have no unwanted kids and no venereal diseases. I knew I'm unlucky enough for me to be the one.

I took heed to the education. The problem is many don't, even though they know - yes, know - the risks. So let's get everybody tested, and everybody knows what is up.

"This test is bullshit. I can't have HIV." After two or three notches on the bedpost, reality may set in for that person, and another two or three people.

My wife is hotter than your wife.

[livendive 8]

Quote

My issue is that we may have government spending money on a program that is fundamentally useless until such time as these issues can be resolved. It's good for statistical tracking of a disease, but not necessaruly for prevention, etc.

Did you see this part of the original post?

Quote

One-quarter of the 1 million Americans with the AIDS virus don't know they are infected, and that group is most responsible for HIV's spread, CDC officials said.

Letting those people know they have HIV could substantially reduce the number of new infections. The rest of your opinion just seems so pessimistic that I don't know how to respond to it.

Blues,
Dave

"I AM A PROFESSIONAL EXTREME ATHLETE!"
(drink Mountain Dew)

[Beverly 1]

Quote

Quote

America has billions of people

You might know a lot about HIV rates in southern Africa but you could use a refresher in population geography of the northern hemisphere.

The USA does not have "billions of people."

Sorry I stand corrected: Out of the 331 473 276 people (Give or take a few) that live in North America, only 1.2million are known to be infected.
Stats are normally under read on HIV/AIDS as many people don't know their status.

The point was in a smaller population of people (approx 60-70 million in SADC Africa), nearly one in every three people have HIV or AIDS. (24 million people that know their status as being positive. This excludes all the people that don't know)

The Western world has done a good job in educating and managing the disease.
These things will just make it better.

Have you ever thought that if you know you are HIV positive and you have unprotected sex with some one and do not disclose your status you should be held liable for attempted murder. As you have just written them a death sentence.

Just a thought - use it, don't use it.

I think true friendship is under-rated

Twitter: @Dreamskygirlsa

[jakee 1,564]

Quote

Have you ever thought that if you know you are HIV positive and you have unprotected sex with some one and do not disclose your status you should be held liable for attempted murder. As you have just written them a death sentence.

Several people in the UK have been found guilty of GBH (Grievous Bodily Harm) for reckless transmission of HIV to others.

Do you want to have an ideagasm?

[rehmwa 2]

Quote

Wouldn't we get the same benefit out of just educating people, encouraging them to ask that all potential partners show recent hard-copy test results?

You could laminate it and wear it around your neck when going out. "How you doin', I'm not infectious, can I buy you a drink? Check out this recent test date....."

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[lawrocket 3]

Quote

Did you see this part of the original post?

--------------------------------------------------------------------------------
Quote
--------------------------------------------------------------------------------


One-quarter of the 1 million Americans with the AIDS virus don't know they are infected, and that group is most responsible for HIV's spread, CDC officials said.

--------------------------------------------------------------------------------


Letting those people know they have HIV could substantially reduce the number of new infections.

Yes, I saw that. And substantially decreasing the number of infections is a good thing - a great thing. The part that has me so pessimistic is that the quarter of people who don't know they are infected are not responsible for ALL infections.

Unfortunately, I have become quite cynical with a lot of things. My line of business allows me to see a great deal of the lower end of human nature. I am somewhat jaded - much more so than a few years ago.

When you've got resistant strains of HIV going around, doesn't it tend to indicate that people being actively treated are spreading it?

I don't know how to respond to it, Dave. I think that required testing would be a good thing, but it's usefulness is limited by privacy concerns and lack of self control.

My wife is hotter than your wife.

[Flying-Wench 0]

*wades into the debate*

Hi Guys. New to this site, new to skydiving.. new to alotta things in life just lately... including HIV.

Been reading older posts on here.. great to see the topic of HIV being discussed openly. Nice to see also that you guys are quite up to speed with your info.. this tells me that the education process is working to a point. However, as has been pointed out, and as with alot of things, the awareness is there in society, but the behaviour change isnt quite.

HIV testing as part of standard testing? Absolutely. As educated and smart as most people are, we still make mistakes for some reason or other.

In Australia, heterosexual infections are alarmingly on the rise, particularly in young men and women. Many are in long term relationships and are being infected by cheating partners who did not know that they had contracted the virus. These people didnt think to be tested, because dont see themselves as high risk, as to this day people are still recieving messages that it is a disease of the Gay and IV Drug community! Plus there is the "i only slept with one person" or "i only did it once" "how could i be high risk?". Their unknowing partner wouldnt think of being tested, because as far as they are aware, they are in a manogamous relationship!

Sadly, only some of these people find out during sero-conversion (when a person becomes ill just after infection - body's response to the virus). This is a process in itself, as the HIV test is not standard and is only undertaken if you are "high risk" or as a last resort for the doctors trying to work out what is wrong with this sick person. However, many infected people do not become ill with seroconversion.. and so continue on not knowing that they have the virus.

I feel that standard testing would slow the rate of infection, especially amongst the rising cases such as outlined above. Counselling is also an absoluate must after testing. Im unsure how the privacy issues would be tackled with.. but there must be a way around it. I personally dont particularly consider HIV infection to be a private issue for a person if you plan on having intercourse with someone. It then becomes both of your problems.. etc etc.. I feel that disclosure should be encouraged, to banish the stigma and personal attacks HIV+ people suffer. In my experience, more talking about it.. leads to education.. leads to behaviour change when people realise that they too could be at risk.

There is a need for a change in HIV education, to get away from the "scare tactics" of recent years.. and into some real case study based stories. There is aso a need for increased participation in support groups. As treatments for the virus have progressed, with new antiviral meds etc, HIV is no longer the "death sentence" that it was 20 years ago.. HIV+ people are living longer and with a better quality of life. As good news as this is for the HIV community, it has had an impact on support and advocacy groups. HIV+ people no longer feel in need of support (as compared to 10-15 years ago) and participation in these groups has somewhat dropped..

Having said all of that, i do agree that education alone isnt going to prevent new infections. In NSW, there are laws in place that make it a criminal offence to have intercourse with someone without disclosing your status. As on the right track as this is.. again, this only works for the people that are aware of their status.

Education, banishing the stigma, combined with standards testing and legislation.. i feel could greatly slow the rate of infection.

Keep up the excellent debate.. its all part of the education process. And if you want some reading on how HIV has impacted 4 womens lives.. clicky on www.positivewomen.org.au/content/view/21/53/

Well i best leave it there.. i didnt intend my first post here to be quite so long. lol apologies for bleeding eyeballs.

Freethefly.. huge cheers and hugs to you. Drop me a PM sometime..

FW