…unless you look for it. In some of my previous posts (here, and here, and sort of here) I’ve written about encountering HIV in clinical practice. I don’t work with a population that is disproportionately poor, black, gay, drug-using, or any of the other socio-economic markers people associate with HIV. Given the long latency period of HIV, the CDC now recommends routine testing…
Despite the fact that we think HIV/AIDS lurks only in the corners of society, it really is out there. If a doc like me–working with a general population– diagnoses it, then we are probably missing lots of cases too. Hence the CDC recommendations.
There are many reasons to test routinely for HIV. I’ll go through a couple for you.
Why do it?
First, HIV is asymptomatic for many years, giving someone ample opportunity to pass on the disease. Knowledge of disease status has been shown to reduce risky behaviors, and treatment can significantly reduce transmission risk.
Second, early disease treatment improves survival and health.
Third, people don’t always know that they are at risk. A happily married woman may have no idea that her husband has sex with men. A happily married man may have no idea that his wife is shooting up.
Finally, implementing regular screening relieves an at-risk patient of having to ask specifically for the test.
What are reasons not to test?
Earlier in the epidemic, having HIV conferred considerable social risk to the patient–loss of employment, housing, even physical assault. Also, since effective treatment wasn’t available, people did not feel any urgency to learning their HIV status.
What are some barriers to testing?
Many barriers still exist. In my state, for instance, a detailed consent form must be filled out prior to testing. No such consent is required for any other test, including viral hepatitis (which is transmitted in much the same way as HIV). This consent is helps stigmatize testing, and makes patients afraid.
Also, there is still considerable stigma to having HIV.
Solution, please
Routine testing will go a long way toward helping de-stigmatize HIV. Most importantly (and least likely under the current administration), education! Early sex education, including information about and easy access to condoms is the best way to prevent the continuation of the epidemic.
And if you are planning to write me about the virtues of abstinence, don’t waste your breath (or your bytes).
AMEN! I’m glad that a doctor is promoting regular testing within ALL communities. I agree that regular testing would get rid of the stigma and make the disease more common. People live over 20 years now with this disease. Thanks for you post.
Felipe