Call for routine HIV testing gets mixed response
Call for routine HIV testing gets mixed response
By Judith Graham and Ronald Kotulak
Copyright by The Chicago Tribune
Published May 10, 2006
A government proposal to make testing for HIV as routine as testing for cholesterol is drawing criticism from some Chicago advocacy groups but winning praise from local physicians.
The proposal signifies a major shift in strategy by the Centers for Disease Control and Prevention, which has been frustrated for years by its inability to further reduce the number of AIDS infections in the U.S.
Under the proposed guidelines, doctors would offer tests to all patients between the ages of 13 and 64, regardless of whether they're believed to be at risk for the illness.
To make mass testing easier, the CDC recommends waiving a widespread requirement that patients give their consent in writing and undergo substantial pre-test counseling.
The goal is to identify nearly 250,000 Americans who are living with the AIDS virus but are unaware that they have it. With knowledge of their condition, these people could get treatment sooner and make lifestyle choices that minimize the chance of passing on the virus to others, said Tammy Nunnally, a CDC spokeswoman.
Ann Fisher, executive director of the AIDS Legal Council of Chicago, said that while those are worthwhile objectives, the CDC's new strategy is "terrible."
"A diagnosis of HIV isn't routine, and we shouldn't be treating it like it is," Fisher said. "This is something that changes people's lives, often very dramatically."
The moment patients test positive for HIV, they become unable to purchase health insurance from any company selling individual medical policies in Illinois, Fisher said. But that may not be something people will understand in advance.
The CDC's suggestion that people need counseling only if they receive a positive diagnosis--but not before the test is performed--is similarly misguided, Fisher said.
"They're saying it's not necessary to sit down with someone and talk about the disease and the implications of a diagnosis beforehand. I think that's wrong. That's the time when you want to be educating people and talking about prevention."
In fact, Illinois law requires written informed consent and adequate pre-test counseling for people taking tests, and that won't change if the CDC issues new recommendations, which are voluntary.
But the policy shift is important because it signals a major change in the CDC's AIDS strategy.
Making tests more routine will help reduce the stigma surrounding the disease, Nunnally said.
Dr. William Johnson, medical director of Chicago's Luck Care Center, an AIDS clinic on the South Side, agrees.
Now, when he asks people if they want a test, they often ask "Why me?" Johnson said. If the CDC guidelines go into effect, "I'll just say it's a routine test and we offer it to all our patients," he said. "It'll be easier for some people to accept."
The CDC has long recommended that all pregnant women be tested, and this has helped dramatically lower mother-to-child transmission of the disease, Nunnally said. Currently, fewer than 370 infants born in the U.S. each year are infected with HIV, down from a peak of 1,750 in the 1990s.
But Rick Bejlovec, executive director of Chicago's Test Positive Aware Network, wonders whether adequate services will be available if more people are identified as being HIV-positive.
Unfortunately, the government's "push to test" is not being accompanied by a "push to put more money into education, prevention and improved [services]," he said.
David Munar, associate director of the AIDS Foundation of Chicago, said eliminating written informed consent for tests could eventually lead to abuses and make it possible for some people to be tested without their knowledge. Every patient has a right to know what medical providers are doing, he said.
The American Medical Association supports the new CDC policy and so does Dr. Mary Lang Carney, chair of the department of family medicine at Evanston's St. Francis Hospital.
"I think it's a great idea," she said, adding that asking patients whether they'd like to have the test "will be an easy question" to raise.
If the CDC issues its new guidelines this summer, as expected, "we'll meet as a practice and decide if we're going to get on board with this," said Dr. Stephen Bennett, director of the Family Medicine Center at Advocate Christ Medical Center in Oak Lawn. He'll recommend that the center adopt the CDC recommendations, to the extent possible under Illinois law.
"The fact that we're not identifying a large number of people who have [HIV] tells us we should be doing something different," Bennett said.
----------
jegraham@tribune.com
rkotulak@tribune.com
By Judith Graham and Ronald Kotulak
Copyright by The Chicago Tribune
Published May 10, 2006
A government proposal to make testing for HIV as routine as testing for cholesterol is drawing criticism from some Chicago advocacy groups but winning praise from local physicians.
The proposal signifies a major shift in strategy by the Centers for Disease Control and Prevention, which has been frustrated for years by its inability to further reduce the number of AIDS infections in the U.S.
Under the proposed guidelines, doctors would offer tests to all patients between the ages of 13 and 64, regardless of whether they're believed to be at risk for the illness.
To make mass testing easier, the CDC recommends waiving a widespread requirement that patients give their consent in writing and undergo substantial pre-test counseling.
The goal is to identify nearly 250,000 Americans who are living with the AIDS virus but are unaware that they have it. With knowledge of their condition, these people could get treatment sooner and make lifestyle choices that minimize the chance of passing on the virus to others, said Tammy Nunnally, a CDC spokeswoman.
Ann Fisher, executive director of the AIDS Legal Council of Chicago, said that while those are worthwhile objectives, the CDC's new strategy is "terrible."
"A diagnosis of HIV isn't routine, and we shouldn't be treating it like it is," Fisher said. "This is something that changes people's lives, often very dramatically."
The moment patients test positive for HIV, they become unable to purchase health insurance from any company selling individual medical policies in Illinois, Fisher said. But that may not be something people will understand in advance.
The CDC's suggestion that people need counseling only if they receive a positive diagnosis--but not before the test is performed--is similarly misguided, Fisher said.
"They're saying it's not necessary to sit down with someone and talk about the disease and the implications of a diagnosis beforehand. I think that's wrong. That's the time when you want to be educating people and talking about prevention."
In fact, Illinois law requires written informed consent and adequate pre-test counseling for people taking tests, and that won't change if the CDC issues new recommendations, which are voluntary.
But the policy shift is important because it signals a major change in the CDC's AIDS strategy.
Making tests more routine will help reduce the stigma surrounding the disease, Nunnally said.
Dr. William Johnson, medical director of Chicago's Luck Care Center, an AIDS clinic on the South Side, agrees.
Now, when he asks people if they want a test, they often ask "Why me?" Johnson said. If the CDC guidelines go into effect, "I'll just say it's a routine test and we offer it to all our patients," he said. "It'll be easier for some people to accept."
The CDC has long recommended that all pregnant women be tested, and this has helped dramatically lower mother-to-child transmission of the disease, Nunnally said. Currently, fewer than 370 infants born in the U.S. each year are infected with HIV, down from a peak of 1,750 in the 1990s.
But Rick Bejlovec, executive director of Chicago's Test Positive Aware Network, wonders whether adequate services will be available if more people are identified as being HIV-positive.
Unfortunately, the government's "push to test" is not being accompanied by a "push to put more money into education, prevention and improved [services]," he said.
David Munar, associate director of the AIDS Foundation of Chicago, said eliminating written informed consent for tests could eventually lead to abuses and make it possible for some people to be tested without their knowledge. Every patient has a right to know what medical providers are doing, he said.
The American Medical Association supports the new CDC policy and so does Dr. Mary Lang Carney, chair of the department of family medicine at Evanston's St. Francis Hospital.
"I think it's a great idea," she said, adding that asking patients whether they'd like to have the test "will be an easy question" to raise.
If the CDC issues its new guidelines this summer, as expected, "we'll meet as a practice and decide if we're going to get on board with this," said Dr. Stephen Bennett, director of the Family Medicine Center at Advocate Christ Medical Center in Oak Lawn. He'll recommend that the center adopt the CDC recommendations, to the extent possible under Illinois law.
"The fact that we're not identifying a large number of people who have [HIV] tells us we should be doing something different," Bennett said.
----------
jegraham@tribune.com
rkotulak@tribune.com
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