AIDS: Test Everyone

[Arc]

I can see a lot of benefits but a lot of risks for instituting the following:

Urging a major shift in U.S. policy, some health experts are recommending that virtually all Americans be tested routinely for the AIDS virus, much as they are for cancer and other diseases.
…But two large, federally funded studies found that the cost of routinely testing and treating nearly all adults would be outweighed by a reduction in new infections and the opportunity to start patients on drug cocktails early, when they work best.

"Given the availability of effective therapy and preventive measures, it is possible to improve care and perhaps influence the course of the epidemic through widespread, effective and cost-effective screening," Dr. Samuel A. Bozzette wrote in an editorial accompanying the studies, which appear in Thursday's New England Journal of Medicine.


Anyone have any thoughts or opinion on this proposal?

Oh, sorry, here is the rest of the article on the subject. ARTICLE. (http://www.foxnews.com/story/0,2933,146921,00.html)

[MorWired]

I can see a lot of benefits but a lot of risks for instituting the following:

Urging a major shift in U.S. policy, some health experts are recommending that virtually all Americans be tested routinely for the AIDS virus, much as they are for cancer and other diseases.
…But two large, federally funded studies found that the cost of routinely testing and treating nearly all adults would be outweighed by a reduction in new infections and the opportunity to start patients on drug cocktails early, when they work best.

"Given the availability of effective therapy and preventive measures, it is possible to improve care and perhaps influence the course of the epidemic through widespread, effective and cost-effective screening," Dr. Samuel A. Bozzette wrote in an editorial accompanying the studies, which appear in Thursday's New England Journal of Medicine.


Anyone have any thoughts or opinion on this proposal?

Oh, sorry, here is the rest of the article on the subject. ARTICLE. (http://www.foxnews.com/story/0,2933,146921,00.html)I believe there is still such a stigma attached to HIV/AIDS that anonymity is still a big deal to people when they're tested. I'm not sure that people would embrace routine testing as part of their annual physical, with the results becoming part of their medical records.

Then again, early detection and treatment can result in an ALMOST disease-free life, so I can certainly see the benefits.

[ethics]

Not for it at all.

I am healthy, married, one sex partner, don't do drugs. What are my chances of getting HIV?

Yes yes, I am sure many are too eager to say, "well, if your wife cheated on you..." true, but that's a big if. I am sure many are in the same boat as me? So why the need for tests?

[Steve]

I'm with Leon. Besides which, there's the issue of compliance. It's not like smallpox, where childhood immunizations can be made compulsory prior to school attendance.

How do we compel everyone to be tested, let alone treated, for HIV?

Then there's the mind-set "Oh, we've all been tested so let's have unprotected sex, now!"

Fine. What about the handful of infected, untested renegades? And what about syphilis, gonorrhea, etc.?

It's a fine-sounding idea that won't work in implementation, I believe.

[tke711]

Not for it at all.

I am healthy, married, one sex partner, don't do drugs. What are my chances of getting HIV?

Yes yes, I am sure many are too eager to say, "well, if your wife cheated on you..." true, but that's a big if. I am sure many are in the same boat as me? So why the need for tests?

Agreed. The option for routine testing already exists for those who want it or need it.

[Stiofán]

I've been tested a few times, and I'm sure many of you have as well.

Buy some individual life insurance requiring a blood draw and it'll be checked. If the policy is issued, you're clean.

Interesting note: Magic Johnson was first diagnosed when he applied for a life insurance policy. Without that diagnosis, would he have survived as long as he has? Who knows. Considering the fear this disease seems to foster, most people would not ask for a test like this. But it's a disease, just like any other. The test is now routine and fairly inexpensive. I don't think it should be a mandatory test, but it should be included with any normal blood workup during routine physical exams. This is about saving lives, not outing people.

[Kangaroo]

According to the CDC less than 2% of AIDS cases were caused by accidents or unknown methods (this figure includes perinatal infection, so truly accidental infections are far lower.) That means over 98% contracted the virus via a conscious choice to engage in high-risk behavior.

I choose not to engage in high-risk behavior. I do not want to incur the additional cost of the test.


Perhaps this is motivated by a bureaucracy’s desire for more and more accurate information, a valid motivation.

Or perhaps it is motivated by political pressure from the AIDS activists in an attempt to force the issue to the forefront of public awareness. The already debunked myth that HIV will spread through the hetero, non-drug using population has shown it to be almost exclusively a disease of lifestyle and choices. Hetero contact accounts for 16% of AIDS cases, yet heterosexuals make up 95% or more of the population. Gay men account for approximately 2% of the population, yet account for 55% of the AIDS cases.

It is so difficult to catch and so easy to prevent that public sympathy is rapidly waning or extingished for most new cases. This removes the activists' power base.

[ShinyTop]

We should require mandatory testing. I will not say that any percentage of the population does not deserve the rest of us being tested. It will still catch many cases much earlier and therefore should result in a lower cost of the disease to the country as a whole. And we all gain with that.

[Kangaroo]

Because there is a difference between AIDS/HIV and tuberculosis, anthrax, plague, or small pox. The former is very difficult to contract and the latter are very easy to contract. We can have a real epidemic with the latter, a wild-fire epidemic. The former will never be a wild-fire epidemic. The pathology of AIDS/HIV show it to be an epidemic of bad choices. Why should those who don't make such choices bear a mandatory burden of testing?

[MorWired]

According to the CDC less than 2% of AIDS cases were caused by accidents or unknown methods (this figure includes perinatal infection, so truly accidental infections are far lower.) That means over 98% contracted the virus via a conscious choice to engage in high-risk behavior. Do you consider having sex with your spouse/partner to be "high-risk behavior"? If your spouse cheats on you and you are unaware, how are you "choosing to engage in high-risk behavior"? Did a woman who was raped "choose to engage in high-risk behavior"?
.Or perhaps it is motivated by political pressure from the AIDS activists in an attempt to force the issue to the forefront of public awareness. The already debunked myth that HIV will spread through the hetero, non-drug using population has shown it to be almost exclusively a disease of lifestyle and choices. Hetero contact accounts for 16% of AIDS cases, yet heterosexuals make up 95% or more of the population. Gay men account for approximately 2% of the population, yet account for 55% of the AIDS cases.

It is so difficult to catch and so easy to prevent that public sympathy is rapidly waning or extingished for most new cases. This removes the activists' power base.Not true that it's "difficult to catch" -- it is significantly more infectious for women having sex with infected men than for men having sex with infected women. Just check out the stats in Africa and decide how "difficult to catch" it is -- virgins are used for "cleansing rituals," and get it as a result of their first "sexual experience," or, more accurately, rape.

[ShinyTop]

Two reasons.

1. It will drive overall health care costs down as I already posted.

2. AIDS is evolving which is why it has been so hard to develop counters. If we do not fight an all out war we would look pretty stupid the day we find it has evolved to spreading by means other than what is called dangerous behavior.

[Stiofán]

The cost to check for this when added to the normal bloood screen would be maybe $1 or $2. Next....

[Steve]

I've got no gripe against it being added to some routine set of screening tests. I don't think it's necessary to require a mandatory test, however.

[cdw]

I don't see the need for mandatory testing. And I wouldn't get a mandatory test. If they are taking blood and testing it for something I don't know about, I also don't care for that either.

[Doctor Dan]

I've got no gripe against it being added to some routine set of screening tests. I don't think it's necessary to require a mandatory test, however.

Routine testing isn't mandatory testing.

- Dan

[Steve]

Obviously. The article advocates for mandatory testing. I oppose that.

The discussion here delves into routine testing as part of a suite of testing that many people would undergo as part of their routine health care. I support that.

[Kangaroo]

Do you consider having sex with your spouse/partner to be "high-risk behavior"? If your spouse cheats on you and you are unaware, how are you "choosing to engage in high-risk behavior"? Did a woman who was raped "choose to engage in high-risk behavior"?
No I don't. High risk behavior includes getting tattoos from shops which re-use needles. Injecting drugs using used needles. Having anal sex with another man, or to a lesser extent having sex with the opposite sex without a condom.

Being raped is being victimized. It is not engaging in a behavior. That is a silly question which doesn't address the argument. I trust my spouse; that is the definition of marriage. Are you a betting person? Want to bet on who gets AIDS first? Me, a heterosexual, married, faithful man. Or a homosexual man who doesn't use condoms, has sex with multiple partners every month, and uses drugs. I bet on me, and I'm giving odds. Loooonnggg odds.


Not true that it's "difficult to catch"
Let's see . . . you can be infected with a rhinovirus simply by being in the same vicinity as an infected person, breathing in their exahalations. You can get it from touching an object they touched, even after a considerable time. The most casual contact often leads to infection. Some poor people get two or three colds a year.

To contract HIV one needs to, most commonly, engage in the most intimate contact between two persons possible, and oftentimes no cross infection occurs even after repeated contact.

I think leprosy might be slightly harder to catch.


Shiny, How does it drive down healthcare costs? I think those cocktail AIDS/HIV drugs are pretty expensive. Early detection would drive UP costs. If a person finds out early, they are going on the cocktails and using them for ten, fifteen years before AIDS sets in. If they don't find out early, they probably don't get diagnosed until AIDS sets in and the treatment is much shorter and less expensive.

Regardless, if you wish to be tested, by all means. I don't feel the need to make it mandatory to appease some with political motivations. There certainly is no good reason stated here or elsewhere for mandatory testing.

[ShinyTop]

No good reason you agree with, Kangaroo, no good reason you agree with. Good reasons have been posted.

Early detection would drive UP costs. If a person finds out early, they are going on the cocktails and using them for ten, fifteen years before AIDS sets in. If they don't find out early, they probably don't get diagnosed until AIDS sets in and the treatment is much shorter and less expensive.

Psst, it drives down healthcare costs because the disease does not hit the point where they are hospitalized months on end. Of course, let's not consider the cost in human misery, after all, it is just their own fault.

Actually it is expected that early detection can result in longer lives, maybe even to where a cure is found. But let's not waste money.


I know I should be careful not to read too much into your post, but it would appear you don't want to subsidize the drugs for longer, regardless of their benefit. It would appear you would prefer to let these sinners just die off earlier. I hope I am misinterpreting your post.

I would note that one of my reasons for all out war against this disease was its constant mutation. Note the other thread about a new strain announced this week. When it mutates to where it is easier for the less careless, those more worthy of saving, to catch it I would hope we are not all asking why we did not take action earlier.