Archive for Wednesday, June 30, 2010

Opinion: Testing should be regular

June 30, 2010

When Jennifer learned she was HIV-positive, she was dumbfounded. Neither she nor her doctor believed she was at risk of becoming infected with the virus that causes AIDS.

Jennifer, then 24 and living with her parents, got the test at her local health department upon the urging of her new boyfriend. Neither expected a positive result.

"It took three days back then to get confirmation of a positive test," Jennifer said. "Those were the longest three days of my life."

At that time she was dealing with persistently abnormal pap smears, despite treatment. A clinical picture like that can be a sign that a woman is infected with HIV, so Jennifer asked her doctor why she'd never been offered an HIV test.

"You don't fit the bill of someone who would get HIV," her doctor told her. "You come from a good family. You have a decent job. You don't drink. You don't smoke. You don't do drugs. You're a woman living in a small town."

Looking back, Jennifer says she and her doctor were both victims of appalling misinformation.

"We fell into the same stupid trap that says it isn't easy for a woman to get infected with HIV. I'm sure that's one reason for where we are today with the AIDS epidemic," she said.

Where we are today, is nearly 30 years into a deadly pandemic that shows no sign of abating. More than 39.5 million people worldwide are now living with HIV infection. Almost half are women who acquired the infection from male sexual partners, usually their husbands.

More than 1.1 million Americans are infected with HIV, but despite widespread testing almost a quarter of them — 250,000 people — are unaware of their status. This is a tragedy, because the earlier people know they are infected the more likely they will get the full benefit of new, highly effective treatments. Today about 40 percent of people diagnosed with HIV find out too late, after the infection has begun to dismantle the immune system for a decade or more. If the infection is caught early, powerful new drugs can keep it in check and extend people's lives.

People who know their HIV status also can take steps to prevent infection in others. It is thought that individuals who are unaware of their status now account for 50 to 70 percent of new sexually transmitted HIV infections in the United States.

That's why public health authorities, like the Kansas Department of Health and Environment (KDHE) and the federal Centers for Disease Control and Prevention (CDC) are now recommending that HIV screening be offered at least once to all Americans aged 13 to 65 years regardless of risk factors, unless they refuse it.

At KDHE we believe that voluntary screening for HIV should be a routine part of medical care for almost everyone. Getting an HIV test should be no more difficult than getting your cholesterol level measured, or having your blood pressure checked. We are also aiming to cut logistical barriers to HIV testing by asking providers to eliminate written consent forms and replace them with a patient's verbal consent. In addition, we have asked that extensive counseling be reserved only for cases where the test indicates the presence of the virus.

It is hoped these changes will make universal screening more feasible in busy medical practices, and allow more people with unsuspected HIV infection — like Jennifer — to find out their status in time to protect themselves and their partners.

"Nowadays there are great benefits in getting tested," Jennifer said. "It's much better to get started early on treatment and hit it hard. Doctors really know what they are doing now."

When I last spoke with Jennifer she had just celebrated her 40th birthday. Except for the 11 pills she swallows every day —never missing a dose — you'd never know she's got HIV. When it comes to preventing HIV and AIDS, knowledge is power. No vaccine against HIV infection is yet available, and none is expected soon.

The best way to protect yourself is to know your status, as well as your partner's. Testing today is easy, accurate and fast. You may not even need to give a blood specimen. If your health provider isn't suggesting that you get tested for HIV, consider asking for the test yourself. Alternatively, you can simply send a text message with your zip code to KNOWIT (566948) to find an HIV testing center near you.

— Dr. Eberhart-Phillips is the Kansas State Health Officer and Director of Health in the Kansas Department of Health and Environment. He can be reached jeberhart-phillips@kdheks.

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