Primary Care Doctors Urge HIV Tests for All U.S. Teens, Adults

[struggle4progress]

Source: Bloomberg

By Rob Waters

Dec. 1 -- The group representing U.S. primary care physicians is urging its members to offer testing to all patients older than age 13 for HIV, the virus that causes AIDS, as a way to identify people who unknowingly carry the disease and might pass it to others.

The new recommendations from the American College of Physicians, whose 126,000 members are internists, are similar to guidelines issued in 2006 by the U.S. Centers for Disease and Prevention in Atlanta.

Until 2006, the CDC only recommended testing people at high risk of getting HIV, as well as those who already have symptoms. In the 2006 guidelines, the agency rejected that philosophy and urged an end to requirements for written patient consent and pretest counseling, saying they endangered public health. The college now says it agrees with that approach.

“ACP recommends that physicians adopt a routine screening policy for HIV and encourage their patients to get tested, regardless of their risk factors,” said Amir Qaseem, a senior medical associate for the college and lead author of the new guidelines released today, which is World AIDS Day. The new policy appears on the Web site of the Annals of Internal Medicine ...

http://www.bloomberg.com/apps/news?pid=20601103&sid=abYOgeDGmH24&refer=us

Read more: http://www.bloomberg.com/apps/news?pid=20601103&sid=abYOgeDGmH24&refer=us

---

Our Country Is Failing the AIDS Test
By Sanford F. Kuvin
Monday, December 1, 2008; Page A17

AIDS remains the world's No. 1 health threat and in the United States is a grave risk to black people in particular. As Phill Wilson, executive director of the Black AIDS Institute, put it, "AIDS in America is a black disease ... about half of the just over 1 million Americans living with HIV or AIDS are black."

Yet the disaster of AIDS in black or white America does not have to be this way. While a cure is still years away, a nation with U.S. literacy rates and levels of cultural and public-health sophistication is capable of greatly reducing its number of new infections. So why are new AIDS cases, particularly among blacks in urban areas, outpacing gains in control, treatment or education among high-risk groups?

The answer lies in the unwillingness of the Centers for Disease Control and Prevention to adopt control measures, including routine mandatory testing among broad age groups. Any time blood samples are taken from U.S. residents ages 13 to 64, such as in an emergency room, physicians should have the right to scan for HIV. For those who don't regularly visit a doctor, blood tests could be scheduled, with the results recorded by states and the CDC. As The Post reported last week, a recent study in the Lancet concluded that such measures, accompanied by treatment for all those who are HIV positive, have the potential to end the AIDS epidemic in Africa within a decade. The effects are likely to be faster in this country ...

http://www.washingtonpost.com/wp-dyn/content/article/2008/11/30/AR2008113001691.html

[glowing]

1. Not unless universal healthcare is reality..

[LisaL]

3. Good point.

If somebody tests positive as a teen, would that not mean pre-existing condition? Might be hard to get medical insurance with that.

[AngryOldDem]

19. Yes, it would.

Which means that once the teen has to find health coverage on his or her own, he or she would be out of luck. And if it is an adult, if that person is covered under one plan, if they go to a new plan (change employers, for instance), the new coverage could challenge this as a pre-existing condition and deny coverage as well.

Like the poster upthread said -- come back with this when there is some kind of nationalized or universal health care plan.

[OhioChick]

29. You and the previous poster

Make some very serious, valid points.

[AngryOldDem]

30. If nationalized or universal care isn't possible...

...then make plans portable.

This is especially true for those who have chronic conditions.

[Robbien]

18. Or at the very least universal free medical for all who test positive

They should not make it mandatory to test for AIDs unless they make medical treatment for AIDs victims a program given free of charge to anyone who tested positive.

[AlphaCentauri]

57. That could create second class patients

better to have a universal Health Care than crazy people screaming 'all those with AIDS are using our hard earned tax money'

[Cronus Protagonist]

2. Urging, OK. Forcing, Nope

That's all I have to say on the topic.

[Ex Lurker]

4. there are people who simply have no need of an HIV test

elderly people who aren't sexually active, for example. Waste of resources to test someone who knows to a metaphysical certainty they don't have HIV.

[Behind the Aegis]

5. You are making some poor assumptions.

"elderly people who aren't sexually active"

Actually, 'elderly people' (depending on your definition of what "elderly" is) are fairly sexually active and usually don't practice "safer sex" because of the lack of risk of pregnancy (for heterosexuals). Also, HIV is not only spread through sexual contact, but also through other means, such as transfusions. Whereas screening processes are much better than they used to be, the possibility for infection is always there, which is one of the reasons the Red Cross has not removed "have you had a blood transfusion in the past 5 years" from its questionnaire when donating blood.

[Ex Lurker]

35. let me rephrase that

if you have your mental faculties about you, you know whether you've had a transfusion or are sexually active. If the answer is no to both, there's no need to test. Maybe I shouldn't have singled out elderly people and just left it at the long term non-sexually active, of which I suspect there are more than one might think.

[struggle4progress]

7. The disease can be transmitted non-sexually. The latency period may vary and

can extend over many years. One therefore expects that there some infected who were not at obvious risk. Moreover, one cannot always count on people to provide accurate medical/sexual histories. Other things can go wriong as well, such as unexpected HIV screening failures by bloodbanks

So to propose not testing unless there's a known risk, which is the current policy, will miss cases.

[Deja Q]

21. The latency period, unless this was redefined in the last 3.5 years, being

Still possible for a lengthier latency, but the norm* is under 6 months.

* "norm", like "normal", is a misnomer because there is no such thing. Or so I keep getting told.

[struggle4progress]

22. "The period of clinical latency varies in length from .. 1 to 2 years to more than 15 years"

VIROLOGY - CHAPTER SEVEN
PART THREE: HUMAN IMMUNODEFICIENCY VIRUS AND AIDS
THE COURSE OF THE DISEASE
Dr Richard Hunt
http://pathmicro.med.sc.edu/lecture/HIV3.htm

[TrogL]

34. I damn near caught it from a telephone

I was at a hospital emergency room with its usual Saturday night cohort of car accident victims and people who've been in fights. I needed to use the telephone and after I was done, noticed blood on my cheek.

I went immediately to a nurse and she literally dropped everything to get me something to clean it off a sterilize it then go and clean the phone.

[mtnester]

6. Troubling

.. as a way to identify people who unknowingly carry the disease and might pass it to others

and

Any time blood samples are taken from U.S. residents ages 13 to 64, such as in an emergency room, physicians should have the right to scan for HIV. (My comments - what about pre screening for cancer and al other types of diseases...if they were really concerned about public health, and felt this information would be used to actually help people instead of harm them)

and most particularly

urged an end to requirements for written patient consent and pretest counseling, saying they endangered public health

note the bold text - this is one of the ways around HIPAA...identifying a danger to the public or, for police, identifying a suspect who is an immediate danger. Both are ways around health information privacy.

And no one here actually believes any information of this type, given to the insurance industry, as it most certainly will, will be used to help people...do they?

[struggle4progress]

9. One question is how seriously you take the epidemic. Tuberculosis was

common at one time in the US, but has been limited by mandatory screening of many populations, including some school and college students. Medical privacy issues are extremely important but are not always paramount: syphilis was a widespread public health problem a century ago, and its prevalence was significantly reduced by combining reporting requirements with treatment

[mtnester]

11. I see the foundation being laid though with the use of specific wording

such as public danger, et al.

The TB outbreak came during a different time, and is a different type of contagion.

Even during the syphilis outbreaks, I do not believe every person over 13 was rounded up and required to submit to a test. This new suggestion does not call for testing with symptoms, it calls for round table testing of everyone over the age of 13, irrelevant of their history, whether they were symptomatic, etc.

And again, since this would NOT be an anonymous test like it is for those who of their own free will get tested, as indicated by CLEARLY identifying people so they could not pass it along, most definitely the insurance companies would get hold of it, and nothing good comes from that, not without universal health care....not in today's world.

[struggle4progress]

14. Despite your claim, there seems to be no call to "'round up every person over 13"

and require them to submit to testing

[mtnester]

15. The short step from "recommend for everyone over 13"

to the mandatory is a quick, easy step. The "public risk" clause in the HIPAA act was designed as a get around.

The grumbling is there, and should be watched closely.

[struggle4progress]

16. If people want to push for strong and effective privacy laws, I'll run to support that;

if people want to push for insurance reform that prevents companies from excluding pre-existing conditions from coverage, I'd run to support that; if people want to push for national health care that respects privacy and gives everyone access to preventative care and effective treatment, I'd run to support that, too

But frankly, I've grown tired of bullshit talking points that try to whip up hysteria as a way of preventing anyone from doing anything meaningful to address real problems: HIV/AIDS is a killer in the US and around the world, and the best current hope of eliminating it is to prevent transmission, which requires knowing who has the disease as soon as possible after infection

[mtnester]

37. It would be easier to address ALL those issues if

the initial concerns weren't immediately stated as a "whipping people into a frenzy" mentality.

First thing, reinstating full/additional/adequate (whatever the proper term for you would be) funding for treatment/a cure would be a BETTER first step than testing everyone to see if they carry the infection. No one had to test all women first for the HPV virus to see if Giardasil could be developed and effective.

Second, reinstating a REAL AIDS awareness program, and funding for it, for our young/old/middle folks would be another good idea. Ongoing AIDS awareness or PSA's even would be a good idea.

Testing everyone would also solve exactly HOW the real issue of the current, often times deliberate or uncaring spread of this disease in other areas of the world? Could it really work if you tested everyone, and rounded them up for containment in some areas? Is there not another way to address this? Would dealing with the strife that caused that particular type of attitude be a better first step (addressing poverty and civil strife)? Or would talking about or trying to change long held cultural taboos and traditions be a better idea. Could THAT work? I don't know.

The premise of mass testing would not work, IMO, without the stronger privacy and insurance/healthcare reform as you stated....which is/was the point of it all to begin with when I originally posted. In a world where daughters are asking their fathers to test for the breast cancer gene because they fear denial as pre-existing if they themselves do, and pray the insurance companies don't find out their father has it and then try to link THAT TOO as pre-existing, it makes perfect sense to make that leap to not trusting the end result of what may have started out as ONE way to consider how to handle a situation.

[Dinger]

13. Yup

troubling indeed

[Horse with no Name]

8. ummmm no thanks

There is a reason this test is optional AND you have to sign waivers to be tested.
I personally wouldn't want this attached to my resume...especially if I wasn't symptomatic.
They want to build a database with this information for their insurance buddies.
Sorry, not interested.

[struggle4progress]

12. Current estimates are that about 0.23% of the population has HIV; in the US,

about 56K new infections may occur each year. The disease is extremely costly to treat: say, $400K-650K per patient lifetime. If these numbers are stable (that is, if one assumes new cases are matched by deaths), then treating all HIV patients could cost up to $36 billion annually. It is much less expensive to prevent new cases than to treat them

Privacy issues should be a major concern, of course, in our current culture, especially insofar as corporate America can essentially construct arbitrary databases at present -- but those issues should be addressed head-on


Estimation of HIV Incidence in the United States
H. Irene Hall, PhD; Ruiguang Song, PhD; Philip Rhodes, PhD; Joseph Prejean, PhD; Qian An, MS; Lisa M. Lee, PhD; John Karon, PhD; Ron Brookmeyer, PhD; Edward H. Kaplan, PhD; Matthew T. McKenna, MD; Robert S. Janssen, MD; for the HIV Incidence Surveillance Group
JAMA. 2008;300(5):520-529
http://jama.ama-assn.org/cgi/content/abstract/300/5/520

Lifetime cost of anti-HIV treatment estimated at more than $400,000
A study presented at the Third International AIDS Society Conference on HIV Pathogenesis and Treatment in Rio de Janeiro estimates that the lifetime cost of treating an HIV-positive person exceeds $400,000 and can run as high as $648,000 without discounts on antiretroviral drugs, HIVandHepatitis.com reports. Using data collected from 17 U.S. HIV care sites and a computer model to calculate care costs over time, the researchers predict that adults who begin antiretroviral treatment when their CD4-cell counts drop below 350 cells can be expected to live 24.1 years and will run up a medical tab of between $405,000 with drug discounts to as high as $648,000 without them ... http://www.advocate.com/news_detail_ektid19334.asp

[Hekate]

10. I actually think it should be universal for marriage licenses,like the very-curable syphilis test is

Have thought so for years.

Back when the Wasserman Test for syphilis was first mandated for getting a marriage license, it was an incurable social disease that had serious consequences for most people and was transmitted to unborn babies by their infected mothers, with devastating consequences to the infant. No one wanted to think about it or talk about it, and there was a tremendous amount of shame connected to having it. Sound familiar?

Public health authorities thought it was important enough to put this little punctuation mark on an important rite of passage, and since everyone had to have the test there was no shame in having the test.

Syphilis is now curable with penicillin, but afaik we still are required to get that test.

Since sexual activity is pretty widespread outside of marriage--before, during, after, in lieu of-- from a public health standpoint it makes sense to make screening tests for HIV universal right about the same time we get universal health care. There's no shame in having a test done that everyone is having done.

Hekate

[CBGLuthier]

26. Blood Test no longer required in some states

Can not find a list of which do and don't but I know at least a few have repealed the blood test requirement.

[Tesha]

32. Just FYI and with no particular regard to your point:

There's currently no blood or other testing required
to obtain a marriage license in New Hampshire.

Tesha

[Vinca]

17. What will they do with those who test positive?

Without universal healthcare many won't be able to afford treatment.

[struggle4progress]

24. So maybe there's a piece of a buildable coalition for universal healthcare

[kimmerspixelated]

47. They will probably try to see if there is good cause

to start producing a vaccine with the stats and their findings! The American Medical Association/FDA/Big Pharma all want all of us to be vaccinated out the wazoo!

[Deja Q]

20. Haven't had one in years. Also,

haven't touched, been touched, by7 any person, shared needle, or any urban or suburban myth.

Do it with a fresh needle and I'll be happy to take another test to prove the damn point, no pun intended.

I wonder who would object... and why.

[struggle4progress]

23. Persistent Lack of Detectable HIV-1 in a Person with HIV infection, Utah, 1995

... It has not yet been determined why this individual's antibody tests were negative, but the investigation has revealed that it is most likely due to a rare immune reaction by the patient. It is well recognized that there is a "window period" from the time of HIV infection until the time the immune system has produced enough antibodies to the virus to be detected by antibody tests. This period is usually several weeks. After this initial window period, it is rare for a person to continue to test negative for HIV antibodies. This individual was clearly not in the window period; clinical symptoms of advanced HIV disease had already developed ...

http://www.cdc.gov/media/pressrel/hiv.htm

[Deja Q]

40. Scary. Thx for the info.

[WriteDown]

25. Testing should be mandatory....

and hopefully it will under UHC. Required testing and required visits are the most effective way of battling these types of diseases.

[snooper2]

27. Any time they do a blood test they should look for it...

I had a blood workup done for an infection in my knee ( staff ) and I asked and the doctor and he said no, they don't automatically look for STD's....

Which is really fucking stupid....They already have your blood and it's going to the lab


People who don't want this done are the same ones who don't get tested and pass it along...or are in denial and don't want to be proven wrong....

[WriteDown]

28. Exactly..

I actually think that blood should be screened every year or maybe even every 6 months.

[crim son]

36. It may seem fucking stupid, but for all the reasons posted here,

there's an argument for not testing. Having said that, I know that for particularly bloody surgeries, at least one hospital routinely checks for AIDS, to protect the surgeons and other medical personnel. I don't blame them, but am always concerned about the healthcare cost ramifications of a positive diagnosis. It's really no small issue.

[LeftHander]

46. So when you find out you are positive and they drop your insurance..

What do you do then?

[slackmaster]

31. I think this is overkill for people who have NO risk factors

Someone who is either sexually abstinent or in a long-term monogamous relationship in which both partners have tested negative, who do not use IV drugs, who do not work in an occupation that exposes them to risk of infection by contaminated sharp objects, is just not going to get or transmit HIV.

[La Lioness Priyanka]

48. people lie. both to themselves and others. so its very rarely overkill.

[closeupready]

54. But do you agree that all people should be forced to be tested,

even if they don't want to? If so, you know I respect you, and I'd like to wrap my mind around why you feel that way. And I may post some follow up questions. Thanks. :hi:

[La Lioness Priyanka]

55. no, i dont think anyone should be forced to be tested. i just think doctors do not mention an HIV

test as part of a routine check up as often as they should

[closeupready]

56. yeah, I agree that's probably true.

I am personally offended and disgusted with those here who argue in favor of mandatory testing.

That's little different than Buckley's arguments from the 80's that HIV+ individuals should be tattooed.

[WriteDown]

58. I am in favor of both mandatory testing and mandatory checkups.

And hopefully both will be staples when we get UHC. Preventative care is a MUST.

[closeupready]

60. I know you are. I read this thread yesterday.

n/t

[closeupready]

61. BUT, I should add so as not to be vague, you have not explained

1) why it would be acceptable to you to give the apparatus of the state coercive power to interfere in medical decisions which, in a free society, remain the exclusive province of, duh, the individual after consultation with his/her doctor; and 2) why it would be presumably acceptable to you to mandate such interference EVEN IN THE ABSENCE OF universal health care - if that is not so, please correct me, but if it IS so, perhaps you'd like to explain.

[WriteDown]

62. I did not say in the absence of UHC....

I was referring to it being paired with UHC. I think if you want to use UHC, you need to be willing to help prevent and eliminate virulent diseases such as HIV.

[slackmaster]

63. People lie about all kinds of things all the time, but that doesn't justify coerced medical tests

:nuke:

[La Lioness Priyanka]

65. i wasnt agreeing to coercion, i was saying people who claim they dont need HIV tests are frequently

lying. to themselves and others.

i am against coerced tests. i do think doctors should urge patients to get tested for HIV when they get checked for other things (blood sugar and whatnot)

[Tesha]

33. 'Bought any serious life insurance lately?

You *WILL* agree to be tested for HIV or you
*WON'T* be buying that policy at any reasonable
rate!

Tesha

[LeftHander]

38. Primary Care doc job is to eliminate risk for insurance Co.s

Identify high cost patients and get them out of the system before they eat into profits.

[Runcible Spoon]

39. BINGO! until the insurance issue is figured out, testing people without consent could have...

disastrous consequences. Insurance companies would just LOVE a database of HIV poz so they can pre screen out for "preexisting condition"...

Any kind of mandatory testing would have to be 100% anonymous, IMO.

[struggle4progress]

42. HIV Testing (CDC)

... In September 2006, CDC released Revised Recommendations for
HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. These new Recommendations, which replace CDC's 1993 Recommendations for HIV Testing Services for Inpatients and Outpatients in Acute-Care Hospital Settings, advise routine HIV screening of adults, adolescents, and pregnant women in health care settings in the United States ... http://www.cdc.gov/hiv/topics/testing/

[struggle4progress]

43. Universal test 'would slash Aids' (WHO via BBC 26 Nov 08)

Page last updated at 05:12 GMT, Wednesday, 26 November 2008
By Imogen Foulkes
BBC News, Geneva

Universal testing for HIV, followed by immediate treatment could cut the number of people developing full-blown Aids by up to 95%, a Lancet study says.

The World Health Organization (WHO) also found that such a strategy could virtually eliminate HIV transmission.

The study used computer modelling to project what would happen if everyone over 15 was tested every year ...

Diagnosis and immediate treatment with anti-retroviral drugs could, researchers say, reduce cases of Aids in a generalised epidemic from 20 in 1,000 people to just one in 1,000 within 10 years ... http://news.bbc.co.uk/2/hi/health/7749437.stm

[closeupready]

44. Seems to me you are the one whipping up the hysteria here.

n/t

[struggle4progress]

50. Wow. On World Aids Day, I post: (1) news about related events around the world;

(2) an article about the decision of the American College of Physicians to support earlier Center for Disease Control recommendations for widespread testing as a way to reduce the spread of the epidemic; and (3) news about modeling done by World Health Organization researchers indicating that widespread testing coupled with immediate antiviral therapy could potentially reduce the incidence of the disease twenty-fold in a decade

And your interpretation is: that's whipping up hysteria

Wow

World leaders pledge to fight HIV
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=102x3624942

Primary Care Doctors Urge HIV Tests for All U.S. Teens, Adults
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=102x3624808

A Breathtaking Aspiration for AIDS
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=103&topic_id=406205&mesg_id=406205

[closeupready]

52. Wow is right - wow that you favor state intervention in medical decisions between patient and doctor

Fuck that. Medical decisions should be left solely to patient in consultation with doctor, and for the law-abiding citizen, HIV tests should always be strictly consensual.

[struggle4progress]

53. Yawn. Anyone wanting to know what I actually said, can read the thread.

Have a lovely day :hi:

[recoveringrepublican]

45. "...followed by immediate treatment...."

I have yet to meet any one with HIV/AIDS, but I assume it is a costly disease, with or without insurance.

For the short time I was between insurance companies, I could barely afford to see the doctor for a strep throat, let alone treatment for AIDS.

[closeupready]

41. As others have pointed out, I would not cooperate unless there is universal health care, and they

can't make me.

[HiFructosePronSyrup]

49. Dammit.

I was going to post that the conspiracy theory nuts were about to show up.

But they already beat me.

[struggle4progress]

51. There are some lessons to take from this thread:

(1) The lack of good privacy laws in the US, combined with the ability of health insurers to exclude "pre-existing conditions", is limiting our ability to control health care costs through good preventative testing

(2) It may be possible to curtail the HIV/AIDS epidemic, but that will require a significant international (organizational and monetary) commitment to educate people, to test people, and to make anti-viral therapy widely available

[AlphaCentauri]

59. also health care has to be seen as a service not like a product n/t

[noonwitch]

64. They can test me all they want-I know, without a doubt, that I am HIV negative

There is no way for me possibly to have gotten it, absolutely none. I've never had a blood transfusion, I've never used drugs that involve needles, and, well, I live like a nun.

No one should be forced to take an HIV test, but it should be encouraged among anyone at risk-sexually active people, iv drug users, and people who had transfusions. The earlier you know, the better the options for treatment.

[La Lioness Priyanka]

66. here is where i disagree. everyone should be encouraged simply because people lie

about their risks. i think if docs treated all patients like they do openly gay men, and offered and encouraged testing, it would help a lot.

[taught_me_patience]

67. Many doctors are now

mine did, even though I'm a heterosexual male and had limited partners during between tests. I was reluctant but she talked me into it. I'm glad that she did becuase it's good to know you are hiv free.