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» Got Questions? Get Answers. » SCARLETEEN CENTRAL » Sexual Ethics and Politics » Routine HIV testing

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Author Topic: Routine HIV testing
orca
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quote:
Health officials are trying to persuade doctors to offer HIV tests to nearly every patient in a New York City community hit harder than most by AIDS.

Under a new program announced Thursday, officials have set an ambitious goal of testing a quarter million adults in the Bronx, one of five boroughs that make up New York City, within three years.

"We need every single individual to know their status," said Dr. Monica Sweeney, an assistant health commissioner who specializes in HIV prevention.

Read the whole article here.

I want to know what all of you think about this. Should HIV testing become routine everytime you go in to see the doctor, no matter what the reason? Should they get rid of the consent form and counseling session? How do you feel this will impact privacy rights if patients no longer have to give their consent? What about testing for other STIs? Who should pay for the testing? I'd love to hear all of your thoughts on this.

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Listen, strange women lyin' in ponds distributin' swords is no basis for a system of government. Supreme executive power derives from a mandate from the masses, not from some farcical aquatic ceremony.--Monty Python and the Holy Grail

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Heather
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It's a very sticky wicket, this, but do understand the critical word here remains "offer." The testing isn't being suggested to be mandatory or without consent.

Thing is, a lot of the protocols before had to do with the stigmas around HIV and other STIs more than anything else. People are routinely screened for other serious illnesses without those same protocols, including other illness which is communicable or sexually or socially transmitted (like Hepatitis or TB, for instance). Consents and counseling also don't necessarily have anything to do with privacy, and protocols for all reporting of health information through things like HIPAA already create a lot of those privacy protections. All the same, I don't see anyone suggesting removing consent or counseling, merely the particular consent form involved in current protocols and the particular type of counseling and pre-counseling which has been done up until recently.

As well, any time a patient is diagnosed with a serious illness, of any kind, there are standards of care when it comes to disclosing that to that patient as well as counseling that patient. Someone diagnosed with cancer, for instance, isn't a person somehow less impacted or in need of less sensitivity than someone diagnosed with HIV.

So, when evaluating the changing protocols around HIV, you have to sort through what really is about the best interest when it comes to both public and personal health, and what is about social or cultural attitudes, stigmas and misinformation. And it can be very hard to do that with HIV (and other STIs), since the stigma and the social attitudes are so pervasive and so bound into how HIV always has been treated and approached, and is still.

A lot of the recent or proposed changes to HIV testing and reporting protocols have been about trying to learn to operate outside those stigmas, and to get rid of the problems they created. For instance, the need for medical staff who had all of what has previously been needed to do the current mandatory counseling has often created a problem in clinics when it came to being able to test people as much as people have asked to BE tested. In other words, even when clients are asking for tests, the existing protocols have made getting them tested prohibitive.

[ 06-27-2008, 03:22 PM: Message edited by: Heather ]

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orca
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Ah, I'd understood it to mean that consent wouldn't be required. That was the main point on which I was torn on this issue. So then it would basically be that everytime you go in to the doctor they ask if you want an HIV test, right? Sort of like asking if you want a lollypop or a flu shot. I like the idea of screenings being more available and offered with more frequency especially since some people don't know where or how to get testing done or believe that it's a complicated or time-consuming process, so making it more routine would probably convince more people to get tested.

My question is, who is going to end up paying for it? A lot of people can't afford to even go to the doctor, so I would like it if the government paid for it especially as it is an issue of societal health, but I have a feeling a lot of people wouldn't go for that.

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Listen, strange women lyin' in ponds distributin' swords is no basis for a system of government. Supreme executive power derives from a mandate from the masses, not from some farcical aquatic ceremony.--Monty Python and the Holy Grail

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Heather
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My impression is that they meant the very extended consent forms currently required for testing would be waived, not actual patient consent.

As far as payment goes, one presumes it might depend on if we were talking about public healthcare or private. With public health, we all pay taxes and social security -- including those of us who aren't insured and use those services -- for lots of different kinds of screenings already. But I'm with you: just like things like polio, TB, what have you, HIV is a public health issue and untreated and undiagnosed HIV poses risks to all of our health, so it's in everyone's best interest to contribute to as many people being screened as possible.

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Heather Corinna, Executive Director & Founder, Scarleteen
About MeGet our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Gumdrop Girl
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I read the article this morning. I'm in favor of more widespread screenings. The Bronx clearly has a current and important public health problem that needs to be approached broadly and simply.

I am under the impression that counseing will still be given to patients regarding the test. But yes, simply offering it more would do a lot to get people to say yes. I would bet a big chunk of the population simply hasn't been tested because nobody bothered to prompt them. Some folks just need to be prodded a little.

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eryn_smiles
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Interesting topic Orca.

I think offering screening for everyone sounds quite sensible for this population in the Bronx, especially if HIV is very prevalent there. Offering tests to everyone, also called "opt-out" testing where everyone except those who opt out get the test are shown to increase the number of people tested.

Informed consent is so important. Everyone needs to know things like the difference between HIV and AIDS and about the window period where HIV infection won't be picked up.

I was curious about which HIV test would be used...the venous blood test which takes around a week to get results or the "point-of-care-test" which is a finger-prick/swab and gives a result within 20 minutes, but is less accurate. Do you guys know?

Currently in NZ, we are just starting a programme to screen all pregnant women for HIV along with their normal antenatal blood tests. Government is paying.

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"Caring for myself is not self-indulgence, it is self-preservation and that is an act of political warfare."

Audre Lorde

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