How to Mark World AIDS Day? How About Getting Screened?
Twenty years ago today was the first World AIDS Day. I remember it well. The museum at which I then worked had a ceremony; when it was over, I hugged a dear friend, who was gay, and begged him to be careful.
That was back when most of us thought AIDS only happened to homosexuals. Now, of course, we know that the HIV infection can be spread by unprotected sex of almost any variety as well as by shared needles. More than a million Americans are currently infected.
In 2006, the U.S. Centers for Disease Control and Prevention (CDC) recommended that physicians offer screening to all patients age 13 to 64 unless prevalence of the human immunodeficiency virus (HIV) that causes AIDS is documented to be less than 0.1 percent among their patients.
But as the Post's David Brown reported a few weeks back, that screening's not happening in a big way. Clinicians don't always offer the simple saliva test that can detect HIV, often because they lack time during appointments and because of uncertainty as to whether patients' insurance will cover the test (or the follow-up blood test that can confirm a diagnosis). And many people opt out of testing when it's offered.
The American College of Physicians (ACP) today issued a new practice guideline encouraging doctors to routinely screen all patients older than 13, regardless of risk factors. The new policy is aimed primarily at curbing the spread of AIDS by people who don't know they have the disease and at getting infected people into treatment. The ACP reports that about 20,000 new infections a year are caused by people who aren't aware they're infected with HIV.
The guideline is also meant to help remove the stigma associated with HIV screening, says Douglas Owens, a professor of medicine at Stanford University and chair of the ACP's guideline development committee. Plus, he says, "If you only screen people who tell you about their risky behavior, evidence shows that you'll miss a significant number of people with HIV. People don't always tell you about those behaviors because they're unaware that they put them at risk or because they don't want to disclose" that information. Screening everyone, across the board, no questions asked, should help eliminate those barriers.
The tactic has "worked quite well with women who are pregnant," Owens says. Offering routine "opt-out" screening (in which all mothers-to-be are tested unless they specifically choose otherwise) "has had wide uptake and has reduced transmission of HIV from mothers to babies," he says.
A study published last Wednesday in The Lancet posits that universal screening and immediate treatment, especially in countries where HIV/AIDS is rampant, could eliminate the disease in a decade. The study is controversial, as it's based on mathematical assumptions and hence is entirely theoretical. But it raises hope: This is a disease that could eventually be wiped off the face of the earth.
Speaking of hope: In Washington, which has the highest incidence of AIDS of any city in the United States, a hospice called Joseph's House cares for homeless victims of the epidemic. You can see photographs and a story online today and in tomorrow's Health section.
Jennifer LaRue Huget
December 1, 2008; 7:00 AM ET
Categories: Family Health
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