The WHO is encouraging doctors to do an HIV test on all patients.

In the past, only high risk patients were advised to get the tests, along with pregnant women.

Undoubtably the US press will find some “fundamentalist” minister to naively condemn the policy, or will misquote one, but actually testing every hospital admission for an STD is nothing new. Up until 1970, every hospital admission was tested for syphillis.

Every once in awhile, we’d find a positive in a nice little old lady, and find she had a philandering husband, but had never been checked. Since neurosyphillis is one of the causes of dementia (confusion similar to Alzheimer’s disease), we still test routinely when diagnosing dementia. After all, sex has been around a long, long time…

Testing for HIV has been kept “voluntary” due to the politicized nature of the disease: Gays did not want this as an excuse to discriminate. But in the rest of the world, especially Asia where most HIV is due to drug use, the question boils down to money.

Since HIV was not around fifty years ago, there is a good argument that in conservative societies that testing is not needed in the elderly.

“We have to use such guidelines intelligently,” says Dr R D Lele, who is credited with identifying and treating the first HIV-positive patient of India over 20 years ago. “We only have to target sexually-active persons in the age group of 16 to 45 years, drug users and patients who have undergone blood transfusions,” he says. “What is the point of asking a 65-year-old patient with cough and cold to undergo the test?”

Moreover, as Dr Lele points out, if the test is offered routinely to all patients, there is a danger of false positives. “The HIV test is known to give false positive in case of patients suffering from malaria or chronic liver disease.”

In conservative India, being HIV positive has a severe stigma. However, in Africa, the main obstacle to the test is money.

That is why President Bush has asked Congress to double the amont for HIV funding to cover 2.5 million people, mainly in Africa. Stipulating that a percentage must be used for abstinence training will actually encourage church groups to work in prevention programs, but I suspect the clueless in the US who have little knowledge of the reality on the ground will use it merely to criticize religion.

I have argued elsewhere that allowing outside NGO’s to work with sex workers allows the “official” government to back policies more compatible with the conservative Christian and Muslim populations in many third world countries.


Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she posts medical essays to HeyDocXanga Blog

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