It’s about time.
After spending billions on research and treatment since the HIV/AIDS epidemic exploded in the 1980s, the government recently drew attention to the age-old problem by proposing to make HIV tests a medical standard. The Center for Disease Control and Prevention issued new recommendations for the routine HIV testing of all patients at hospitals, clinics and physicians’ offices. For patients between the ages of 13 and 64, the testing would become part of the regular battery of health tests — as common as blood pressure checks.
Compared to the current voluntary system, the policy would make the detection and prevention of the disease much easier. But, despite the great promise of the new policy, the American Civil Liberties Union has argued against the opt-out testing because it might infringe on patient privacy and cause discrimination issues for HIV-positive patients.
In the organization’s September press release, the ACLU portrayed the government as a suspicious and immoral big brother, collecting information on a patient’s HIV status for dubious reasons. The statement also argued that patients have a right to know how patient data will be used, citing concerns that the information could be used to discriminate against HIV-positive patients seeking housing or work.
“HIV discrimination is still rampant in this country,” stated Rose Saxe, the staff attorney for the ACLU AIDS Project, in the press release. “People continue to lose their jobs and housing because they have HIV.”
But the disclosure of medical records would be required for HIV or AIDS treatment through Medicare and Medi-Cal — or even for workers’ compensation payments. And more importantly, the nation’s understanding — or misunderstanding — of the disease isn’t an excuse to allow patients to unknowingly spread HIV.
Furthermore, standardizing HIV tests would destigmatize the epidemic, allowing the nation to recognize HIV simply as a disease like any other, giving strength to the fight against it rather than continuing to brand it with a scarlet letter.
Other critics of the recommendations, especially those in New York — where the HIV and AIDS testing policy is much stricter than in other states — fear that the CDC has eliminated some elements key to properly testing patients. The abolishment of the once-required written consent form and pretest counseling, they fear, will cause many patients to receive less-than-adequate care or information about treatment options.
Julie Davids, executive director of Community HIV/AIDS, told the New York Times, “The CDC recommendations might lead to more people being tested, but is that going to get them connected with a system of care?”
Similarly, New York City Health Commissioner Thomas R. Frieden raised concerns that patients would not receive proper care because a high patient-to-doctor ratio has led to shortened doctor visits.
But all people who don’t know they are infected with HIV are already without the care they need, and without a positive test, they will never seek it out. And the CDC accounted for the limited availability of hospital resources by suggesting that doctors halt routine testing when positive tests are fewer than one in every 1,000 patients.
Furthermore, an opt-out HIV testing system is more than validated by patients’ typical changes in sexual behavior after testing positive. The Washington Post reported Sept. 22 that “between 54 and 70 percent of sexually transmitted cases of HIV are transmitted by people who do not know they are infected” and that “the frequency with which a person has unprotected intercourse … falls by about 50 percent once that person knows his or her HIV status.”
Knowledge alone, even without the connection to a system of care, can go a long way toward preventing the spread of the virus. And even with the possible challenges the recommendations might present for physicians, the outcome is well worth the cut to treatment costs. Earlier detection means less-serious symptoms, allowing doctors to treat patients in a much less costly manner, while providing patients with a better shot at fighting the virus.
According to the CDC, any chance of decreasing the 40,000 new HIV infections that occur every year or helping those already infected needs to be supported by everyone, not just high-risk patients. After all, this isn’t the uncommon virus it once was. It’s an epidemic and should be treated like one.
