The CDC has now figured out that only 40% of people have been tested for HIV, so is upset about it.
It’s actually the government’s fault. You see, for years, we docs couldn’t test for HIV without jumping through hoops.
We had to “counsel” the patient in details not just about the test but we had to go into details on “high risk behavior”. The lab had to do lots of paper work to “hide” the patient’s identity. Then, you couldn’t just call and say the test is okay, you had to have the person come back for an office visit to get the results.
Needless to say, it was a big bother for us, for the patients, and for the lab, who had to do the work. And in a small town, we had to “blind” the work even on the chart, since if someone found out that so-and-so was getting an HIV test, rumors would fly. Yes, I know all about the strict privacy rules. It’s just that they don’t always work.
Things got a little easier when we started testing all pregnant women for HIV. It was “routine”. So it wasn’t insulting the lady to do the test, and it was very important to find out if she was HIV positive before she had the baby.
THIS TABLE shows that making moms sign a paper NOT to have the test resulted in 80plus percent getting the test; if you made her sign a paper saying she wants the test, only 60 percent get tested.
So mandatory testing is a good idea.
However, now the CDC wants to test everyone over age 13. Well, duh. Their idea is correct: They estimate a quarter million people in “low risk” groups are HIV positive.
Sounds scary, doesn’t it?
The problem? The majority of people are in “low risk” groups, where positive tests are rare: so that is a lot of tests that will be done needlessly. Lots of money wasted.
A quarter million cases out of 200 million people is not a high percentage, especially when compared to some high risk groups where fifty percent test positive.
In low risk populations, the rate of “false positive” tests might be as high as really positive tests. A false positive test, meaning the test is positive but it could be a lab error or another disease, so you have to do another test. For example, an oral test for HIV done in one Boston hospital showed a 4% false positive rate. In one New York City clinic, the suspicious test rate was even higher.
From last November through this April, nearly half of 444 patients who received preliminary positive results at New York health department clinics wound up testing negative when subjected to more rigorous analysis.
“Although, yes, we had 213 instances of false-positives, we were able to get 30,000 people tested, and those that were negative, we could tell them they were negative,” said Dr. Susan Blank, an assistant health commissioner in New York City.
So if you were negative, it was fine (unless, of course, you just caught HIV and the test didn’t have time to turn positive)
But for the others, the false positive test meant a lot of nights worrying you might die while waiting for the retest to come back.
You might wonder: Don’t people know if they are at HIV risk? Well, yes and no.
With the sexual revolution, one may not know one’s partner’s history of experimentation with sex or drugs.Â The spread of HIV in jail is an underreported story. And of course, sexual assault of young girls (including date rape) is alas common. As the baby boomers age, one will see more HIV positive patients in the elderly. And then there is occupational hazard: Doctors, nurses, EMT’s, police and others may be exposed despite precautions.
On the other hand, I am old enough to remember the good old days when we tested everyone planning to marry, everyone pregnant, and every hospital admission for syphillis. Ditto for TB testing, with yearly chest xrays. Is there a differnce here? Probably not.
Since many people lie, and others may be unaware of their risk, yes I do support this testing for pregnant women, sick people, and those going into hospitals. I’d “opt out” for checking HIV with the routine blood tests at physical time or when we draw blood for another reason. Saliva tests at routine office visits? well, we check for immunizations and blood sugar and weight and blood pressure if these testings haven’t been done for awhile, so why not?
I’m not sure I’d start doing the test in health fairs or high school clinics, however..
Each HIV test may only be two dollars (plus labor costs). But that’s still a lot of money if everyone gets tested.
Would the money be better spent on blood sugar testing or mammograms or colonoscopies? That’s the real question….After all, there are 200 thousand cases of breast cancer diagnosed each YEAR…and a lot of uninsured women don’t get mammograms…
Nancy Reyes is a retired physician living in the rural Philippines. Her webpage is Finest Kind Clinic and Fishmarket.Â