By Dan Savage
Tuesday, May 9, 2006
http://www.thestranger.com/blog/2006/05/routine_hiv_testsjus.php
By Dan Savage
Routine HIV Testing–Just Say Yes
Posted by DAN SAVAGE at 11:36 AM
The CDC is recommending that we change our approach to
HIV testing
http://www.cnn.com/2006/HEALTH/conditions/05/09/hiv.testing.ap/index….
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….
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.
I agree 100% with Georgia10 at DailyKos:
http://www.dailykos.com/storyonly/2006/5/9/123010/8639
We cannot stop the AIDS epidemic with a rate of
24%-27% of undiagnosed carriers. Making AIDS testing
as common as an ordinary blood test can go a long
way to dealing with this health crisis.
If everyone who carried the virus knew his or her HIV
status, it would significantly reduce the infection
rate. It wouldn’t eliminate new infections, of course,
but it would bring it way down. Not only would more
people who are currently infected know that they had to
take steps to protect their sex partners, routine HIV
testing would also mean that more people who are
infected would get treatment–and treatment seems to
make HIV-positive people less infectious by reducing
their viral load, which would further cut the infection
rate. It would also lead to more, and more effective,
sero-sorting, the practice of positives seeking out
other positives as sex partners, and negatives seeking
out negatives. Sero-sorting is credited with reducing
the infection rate in San Francisco, of all places.
http://www.latimes.com/news/local/la-me-sfaids1apr01,0,4272516.story?…
Wow! Routine testing for HIV would save lives–so
naturally the AIDS establishment is opposed to the
CDC’s sensible recommendation:
Some patients’ advocates have voiced concern that
the recommendations do not include pre-test
counseling and sufficient informed consent.
You can read GMHC’s take here
http://gmhc.org/about/releases/060404.html
and San Francisco AIDS Foundation’s take here
http://www.sfaf.org/policy/testing/cdc_guidelines.html
Perhaps the CDC’s proposal can be tweaked–who could
object to more counseling?–but the primary reason AIDS
orgs will oppose the new guidelines is that many do
little more than encourage people to get tested and
offer HIV tests. If HIV tests become a routine part of
regular medical care–and it should–it will be harder
for many HIV orgs to justify their expensive,
ineffectual existences.
Please don’t listen to the AIDS orgs on this issue:
It’s past time that we began treating HIV like other
sexually transmitted diseases. That means routine
testing, names reporting, and contact tracing–all
routine public health measures that will save lives,
particularly the lives of African American women.
In a side note: One of the problems with HIV prevention
education in this country is the slogan "Be Safe–Get
Tested," which creates the impression that testing is
safety. I know lots of gay men who regard regular
testing as some sort of retroactive absolution for
whatever unsafe or risky activities they participated
in between tests.
By Dan Savage
http://www.thestranger.com/blog/2006/05/routine_hiv_testsjus.php
permalink
Comments
http://www.thestranger.com/blog/2006/05/routine_hiv_testsjus.php
The only problem I would have with it is how the
insurance companies would react. Would they/could they
dump you or jack up your policy if they see you are
positive? How will employers react? Would they/could
they dump you from their group policy if they find out
you are positive?
Of course, if we were sensible and would just open
medicare up to everyone, this wouldn’t be an issue. I’m
usually fairly retro in my sensibilities, but this
1940′s way of insuring people just sucks.
Posted by: catalina vel-duray | May 9, 2006 12:10 PM
Dan,
I wholeheartedly agree with you that there are a lot of
ineffectual HIV orgs out there. I find it interesting
that there are more and more people interested in
"starting an HIV organization," from scratch, from
ever-dwindling HIV prevention funds. Unfortunately, the
CDC source-of-all-major-funding doesn’t operate on
"survival of the fittest/leanest/most efficient"
policies, but rather on the beliefs of whatever
political party is in power (which means we are all
screwed until at least 2009).
But I digress. I’ve worked in HIV/syphilis
prevention/education/testing/partner
notification/social work for over 10 years, and I
totally see the "Be Safe – Get Tested" thing as
fallacious reasoning, especially for gay men. If
somebody continues with risky behaviors, but continues
to test negative, they either think, "Gee, I must be
doing something right," or worse, yet, "I must be
immune." [I once counseled a guy that swore that
vaseline (and nothing else) was keeping him negative
all these years. His test came out negative; how could
I convince him otherwise?]
Which is why your last paragraph seems to contradict
everything else you said in your blog. How is the
"routine testing" plan different from "Be Safe – Get
Tested?" I think it will also lull people into thinking
that just because they regularly test negative, they
must therefore be "safe."
Let me tell you first-hand, there are a TON of people
that are cajoled into testing for HIV (say, as part of
chlamydia testing and treatment), and if people are not
really ready to be tested, they sure as heck won’t
stick around/come back for the results, and (take it
from me), they sure as HELL don’t want to be found,
especially if their results are positive.
Also, with dwindling resources for HIV/AIDS treatment,
and with an ever-increasing number of people testing
positive (especially with the CDC’s unbrilliant
strategy of mass-testing without accompanying
counseling), are we really doing anyone any favors, by
saying, "OK, I know you didn’t really want to test, and
aren’t ready for these results, but congrats, you’re
HIV positive. Sorry, Ryan White funds have been cut
again, so you’re on a 1-year waiting list to get CD4,
etc. testing paid for, and pretty much have to wait for
somebody to DIE before you can get on the AIDS-drugs
waiting list." ?
While I dread the results of the CDC’s new "routine
testing" incentive, I do agree with your beliefs in
holding people personally accountable for their
actions. I’m an HIV-negative gay man (here but for the
grace of goddess), and it’s pretty much a miracle that
I’m still negative, as over half of my ex’s are now
positive, and I can guaran-fucking-TEE you that they
didn’t give a rat’s ass about my health or safety. I am
35 and negative BECAUSE I PROTECTED MYSELF.
Teach people that they MATTER, and that they have to
look out for themselves – not that it’s the government
(and taxpayer’s) responsibility to test them, give them
the bad news, and pay for their treatment.
Keep up the great writing (even if I disagree with it
sometimes)!
Peace Out
Posted by: tester | May 9, 2006 12:25 PM
BTW – I wouldn’t be so heavy on the praise to San Fran
on being so forward-thinking on lowering HIV rates. The
midwest et al. are always looking to San Fran as the
source of the "next best thing" in HIV prevention. WAKE
UP, HEALTH DEPARTMENTS! San Fran is usually the first
place to find the "worst new thing" – crystal meth,
STD’s du jour, etc. You are perfectly capable of coming
up with your own, effective prevention techniques –
believe in yourselves! Or at least look to Seattle –
their needle exchange program has done a kick-ass job
of keeping down the rates of new IDU-transmitted HIV
infections.
Posted by: tester | May 9, 2006 12:54 PM
| Wow! Routine testing for HIV would save lives–so
| naturally the AIDS establishment is opposed to the
| CDC’s sensible recommendation
Please define the term… AIDS establishment
| "Be safe–Get Tested"
Note every time that this term is used referring to
preventing sexually transmitted infections
the correct term is always…
safer
There’s never zero risk.
Posted by: NotB4WeKnow.blogspot.com | May 9, 2006 01:05
PM
Regarding the comment about health coverage insurance,
can you name a case, an example?…
All’s there has to be is a few cases of that and that
will be the end of that. It’s a disease and should be
treated as a disease.
Regarding the thought experiment…
The strategy.
Get tested together for a variety of sexually
transmitted infections including human immunodeficiency
virus and share the results with your potential sex
partner BEFORE having sex.
Here’s the collaborative blog and wiki about the
strategy of let’s get tested together BEFORE we have
sex… for STDs
http://NotB4WeKnow.blogspot.com
Posted by: NotB4WeKnow.blogspot.com | May 9, 2006 01:23
PM
"Regarding the comment about health coverage insurance,
can you name a case, an example?…"
Read my comments again, please. What I was asking was
how would routine testing affect health insurance
coverage and rates for people who were found to be
positive. I don’t trust insurance companies to do the
right thing, and neither does anyone else who is of
normal intelligence. That’s the only flaw I can find
with routine testing.
Posted by: Catalina Vel-DuRay | May 9, 2006 01:40 PM
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Tuesday, May 9, 2006
http://www.thestranger.com/blog/2006/05/routine_hiv_testsjus.php