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"Should everyone be tested for HIV?"
The
Star (www.thestar.com.my)
(13/08/06)
ONCE it was perceived as a death sentence people would rather not know
whether they had. Now, every American between 13 and 64 could be advised to
take a voluntary HIV test, regardless of whether or not they’re at high risk
of contracting the virus, according to guidelines expected to be published
by the US Centers for Disease Control, Atlanta, Georgia.
The tests would be offered every time an individual visited a doctor, with
the ultimate aim of every person taking at least one test in their lifetime.
The World Health Organization is expected to follow suit by recommending
routine voluntary testing in any country where being HIV-positive isn’t
punishable by law. Lesotho and Botswana have already introduced such
schemes.
The recommendations reflect a turning point in the perception of the
disease, from death sentence to chronic condition that can be readily
treated with drugs. However, the possibility of routine screening also
raises a raft of issues about the availability of such drugs, as well as
concerns about privacy and the rights of the individual vs. what is in the
interests of public health.
Up to 25% of the estimated 1 million HIV-positive Americans don’t realise
that they have it. In many African countries this figure is closer to 90%.
It is statistics like these that have prompted some health workers to argue
that routine testing is the only way to confront the disease.
The problem right now is that many of those diagnosed with HIV don’t find
out until it’s too late to begin treatment. According to CDC figures, nearly
half of HIV-positive Americans only found out they were infected in the year
before they were diagnosed with AIDS.
“They are therefore unable to benefit from prevention and care services that
can reduce morbidity and mortality,” says a CDC spokesperson, adding that
they may unwittingly contribute to the continued transmission of HIV.
Previous research suggests that those who don’t know they are infected are
responsible for 65% of all new HIV infections in the US. Meanwhile,
Americans who do know that they have HIV are 50% less likely to transmit the
virus than those who don’t. Such figures make the case for testing seem
obvious, both for society and for individuals too, but many still have their
doubts.
One of the main problems with the CDC’s guidelines is that they provide no
means of ensuring that people who test positive gain access to treatment,
says Michael Weinstein, president of the AIDS Healthcare Foundation, a US
HIV/AIDS medical provider. A federal government programme called the AIDS
Drug Assistance Programs (ADAPs) has been in place since 1990 to help bring
drugs to those who can’t afford them, but Thomas Coates, director of the
Program in Global Health at the University of California, Los Angeles, says
there’s still a large gap between policy and reality.
“The people most likely to get HIV are the least likely to have access to
healthcare,” he says. “We know that African Americans are more likely to die
younger, die of AIDS, and to not get tested.”
That’s not all. A California Supreme Court decision in July has raised
additional concerns about privacy and the possibility of details about HIV
status and a person’s sexual history becoming public. In the case, a man
known as John B unknowingly infected his wife with HIV. In order to
determine whether or not he was negligent in infecting her, a six-month
period of his sexual history and medical records were opened up to scrutiny
by the court.
If a person’s sexual history and medical records can be made public, even on
a limited scale, some doctors fear that people will shy away from getting
tested. According to Edwin Bayrd, associate director of the UCLA AIDS
Institute, who supports the new CDC policy, the Californian ruling will make
people less inclined to accept the entire testing plan. “We need to
destigmatise testing,” he says. “The effect of this ruling will be to make
that task harder. Just imagine all these retrospective lawsuits surrounding
inadvertent infections brought by people who felt wronged.”
General paranoia also lingers in the US about the existence of a large
database of names of people with HIV that could be opened up to scrutiny by
officials, or worse, hacked into.
However, Kenneth Mayer, director of the Brown University AIDS Program in
Providence, Rhode Island, suggests that although some of these concerns may
be valid, individuals’ privacy needs to be balanced against large-scale
health concerns. “Some people think it’s not good to have all of this
testing information around for anyone to potentially get their hands on. On
the other hand, the public health risk of not having testing is
significant.”
Currently, 44 US states require that people diagnosed with HIV be reported
by name to their county and state health departments. That information is
then passed on to the CDC for statistical purposes, though with the names
themselves removed. All name-based records are kept strictly confidential,
but even this low-level exposure worries Paul Cates of the American Civil
Liberties Union. “As a minimum, people should be informed,” he says. “Even
with high levels of confidentiality, there have been breaches.’’
In 1996, the names of 4,000 HIV-positive people were stolen and mailed to
local newspapers around Tampa Bay, Florida, for example. Many are also
concerned about health insurance premiums going up if they test positive for
HIV, since companies are entitled to restrict coverage or make a decision
about premiums based on any such pre-existing condition.
Since any programme of routine screening for HIV in the US will be voluntary
if approved, the success or failure of such a policy will rest in the hands
of the American public.
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