Experts Torn On Federally-Funded AIDS Testing
Mandatory Testing Would Boost Health, But Is Touchy Subject
POSTED: 1:27 pm CST March 17, 2005
UPDATED: 2:21 pm CST March 17, 2005
BIRMINGHAM, Ala. -- Despite public opinion that it'd boost the country's overall health, local experts agree it would be difficult, although beneficial, to conduct mandatory federally funded HIV and AIDS screenings at doctors' offices.
"I don't know if mandatory testing is going to go over well with the public," said Dr. David Wynne, an internist at Summit Medical Group. "It might keep people away from the doctor's office, not getting other medical attention and other physical screenings as they should."
In a survey conducted in mid-February, 63 percent of the general public and 64 percent of doctors agreed mandatory tests would improve the country's overall health, with both groups stating that health care benefits far outweigh any social implications of an AIDS test.
The survey was conducted by HCD Research, a marketing research and medical information company based in Flemington, N.J., and was in response to two articles recently published in the New England Journal of Medicine supporting regular HIV screenings in all people, not just those considered at "high risk" for the disease. The articles didn't discuss mandatory testing, as many agree that to require HIV testing would be near impossible.
Approximately 1,339 members of the general public and 864 physicians were surveyed.
High-risk people are those who have multiple sexual partners, have had sexual contact with someone who is HIV positive, are homosexual or bisexual males, use intravenous drugs, or have had sex for drugs or money, said Terrie Outlin, sexually transmitted disease program manager at the Jefferson County Department of Health.
Making the testing mandatory is impossible, one local expert said.
"To start, there is no such thing as a 'mandatory' test," said Michael Bertram, administrative director of the 1917 Outpatient AIDS Clinic. "All tests are always voluntary. You can't force someone to take a test."
And even with the surplus of information about HIV and AIDS in popular media, people still aren't taking basic precautions.
"People are still not practicing safe sex, not using protection, don't know their partners," Outlin said. "That's what we're seeing. There are several cases where someone has come in before as being (HIV) positive, and then someone else comes in, also positive, and names the first person, not knowing that person was positive. We see it every day, people not telling their partners they have the disease."
The Health Department, along with several other AIDS service clinics including the 1917 Clinic, offer HIV and AIDS screenings.
"As it is now, it is very expensive to be tested at a doctor's office if (the test) is not covered by insurance," said Karen Musgrove, executive director of the Birmingham AIDS Outreach, a nonprofit organization that offers services to persons with HIV or AIDS.
Musgrove recommended going to a state-funded clinic such as BAO for free testing. The 1917 Clinic offers a rapid results test that show a person's HIV status within 20 minutes. The test uses a cotton swab -- not a needle -- and is rubbed against the inside cheek.
The BAO is still waiting to gain approval to use the test. Now, though, it also uses a swab test, although it can take up to two weeks to get results. The swab test allows medical personnel to go into clubs and bars at night and offer free tests to patrons.
The personnel also regularly test homeless people at their makeshift shelters.
"With the blood test, that wouldn't be feasible," Musgrove said. "It makes it easier to be mobile, and easier to test people, including people who are afraid of needles."
The blood test is still used, however, in some settings, such as at Jefferson County Health Department's sites.
Musgrove said people are also wary of the stigma associated with the disease.
They might not want to know if they are HIV positive, he said.
Last year, the Health Department tested 7,288 people countywide. Of those, less than half -- 3,506 -- returned for their results.
This happens each year, Outlin said.
Of an estimated 1 million people nationwide with HIV, approximately 280,000 people do not know they have the disease, according to the Centers for Disease Control and Prevention in Atlanta.
"HIV testing is a very touchy subject," Wynne said. "To do it in office, you have to explain to the patients that if their test is positive, the Health Department will be contacted through the lab, which will then call the patient, and seek out the patient's past sexual partners in an effort to stop to spread of disease."
In Alabama, testing is confidential. The results are released only to the Health Department, not to families, employers, or insurance companies. To Bertram, insurance companies do pose their own unique problem.
Most high-risk people don't have health insurance and don't see a health care professional on a regular basis, he said.
But testing for low-risk people would still be beneficial, he said.
It isn't only high-risk people that contract the disease.
"For instance, women are getting HIV more and more frequently," Bertram said.
Still, the stigma remains. The 1917 Clinic often finds is that people wait to get tested until they have the symptoms of HIV. By then, treatment might be less successful.
Even once the test proves positive, they sometimes wait for treatment, their response slowed because of the implications of having such a disease, Bertram said.
"But maybe if testing became standard care, maybe the stigma would ease," he said.
It's also cost-effective for everyone to be tested, Bertram said.
"The cost of them not knowing they have it, and the cost of treatment because they end up with AIDS is much more expensive and less successful than if we were able to treat HIV earlier."
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