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Author Topic: State Laws Are Contributing to the Spread of HIV and AIDS  (Read 21820 times)

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Offline Dachshund

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #100 on: October 17, 2007, 10:01:05 AM »
Thanks Tim very interesting and as you mention very timely.
To me the crux of the problem is summed up in this one sentence:

 
  HIV disease is a disease of poverty. In the United States, HIV infection disproportionately affects uninsured, low-income persons

The voices of the poor are seldom heard. Even here at AidsMeds I don't think most of us really know what it is like to be uneducated and poor and positive.  Access to a computer alone makes all the difference in the world. With the click of our mouse we have access to experts, experience, compassion and friends. No question goes unanswered. As a group AidsMeds is far more homogeneous than most effected by the virus. I think (myself included) that we forget that actually we are the minority. We are a vocal, better educated minority, but a minority none the less.  It's a shame the majority of people effected by aids have no voice at all.

Offline jack

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #101 on: October 17, 2007, 10:27:32 AM »
sounds like another good reason to be rich

Offline Ann

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #102 on: October 17, 2007, 11:45:04 AM »
(quoted from the second article Tim Horn linked to) Although patients are more likely to test when their physicians suggest it many physicians do not do so because pretest counseling takes considerable time and discussing sexual and drug behaviors that risk transmission may be uncomfortable.

I can understand talking about drug use may be uncomfortable - because of legal issues - but sex? I think it's high time humanity grew up and abandoned this giddy, guilt ridden attitude toward sex it has. Everybody does it, outside of a tiny minority. We're built to have sex. It's hardwired into our brains. It not only ensures survival of the species, but it is also a social bonding mechanism which ultimately results in a better survival rate as well. 

I can't think of a more normal, natural aspect to our lives. Sex. What the hell is the big deal? People pussy-foot around serious sexual discussions, but will suck up ever last morsel of porn, soap-operas, sex-sells advertising, romance novels, love stories... etc ad nauseum. But ask people to talk frankly about protecting themselves from a deadly disease? They go bright red and say they couldn't possibly talk about it.

World - grow up and get over the fact that people have sex so we can do something constructive to end this damned pandemic. 

Sheesh.

Ann
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HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline thunter34

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #103 on: October 17, 2007, 12:55:54 PM »
The voices of the poor are seldom heard. Even here at AidsMeds I don't think most of us really know what it is like to be uneducated and poor and positive.  Access to a computer alone makes all the difference in the world. With the click of our mouse we have access to experts, experience, compassion and friends. No question goes unanswered. As a group AidsMeds is far more homogeneous than most effected by the virus. I think (myself included) that we forget that actually we are the minority. We are a vocal, better educated minority, but a minority none the less.  It's a shame the majority of people effected by aids have no voice at all.

I think this very thing played directly into the anxiety and depression that fueled my friend Michael's despair.  It wasn't the whole of it, of course, but it was a significant part of it.  It was for this very reason that many of his medical problems had begun to mount, and for this reason that I had become resolved to try to assist him in better understanding his health situation.  That was what I was trying to communicate in earlier threads about him - that he represented that larger segment of the HIV population without more of a voice in his own care. 
AIDS isn't for sissies.

Offline Moffie65

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #104 on: October 17, 2007, 02:15:16 PM »
I would like to add my voice to the chorus in thanks to Tim for those two very good posts.  The articles are very good at defining and expressing the need for all to be involved in the change we would like to see nationally.

Thanks once again.

Love,
The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline mike in VT

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #105 on: October 18, 2007, 07:24:28 PM »
Thank you Tim for posting this report.

While the statement  Early diagnosis of HIV infection and timely access to medical care can improve treatment outcomes [1] and potentially decrease the risk of transmission [2].    does support the CDC’s recommendations for Routine testing as they would in fact detect and HIV infection far sooner than waiting  for more serious conditions to present.   This would in fact reduce the over all health care costs and make the treatment of HIV easier and more successful.  This report also suggest that a “universal “HIV testing also requires "universal" health care for there to be a significant impact on diagnosing HIV infection at the earliest stage possible [14].  It also clearly states that Despite these challenges, HIV infection–related morbidity and mortality continue to decrease [12]. Undoubtedly, much of this success is attributed to government-sponsored programs, such as the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, which provides access to medical care after the diagnosis of HIV infection.    While a universal health care system may in the short run cost more, it will in the long run cost less and save lives.  By early detection of HIV people can make the changes most of us have since our own HIV diagnoses, i.e. use of protection for ourselves and others, healthier living and so many other changes most of us have made to insure that not only will we survive but other will not become infected.  With early detection people will also have more resources available and be able to seek treatment long before it becomes a serious medical problem, thus reducing the cost, not only in treatment but loss of lives. 

 HIV disease is a disease of poverty. In the United States, HIV infection disproportionately affects uninsured, low-income persons [10, 11], who constitute a vulnerable population that often has multiple health care needs.  While this statement does have a bases for fact it also fails to mention that uninsured, low income people make up a significant part of the US population.  Broad statements such as HIV disease is a disease of poverty.  can only further add to the stigma and stereo typing of HIV, thus giving the affluent and wealthy the validation that because of the wealth and social status they are  impervious to the HIV virus.  For this reason many seem to think that they are beyond getting HIV and until a serious health problem strikes them they will go untested.  We all know that HIV could care less about ones wealth or the origin of their parents.  So long as people continue to think of HIV as a poor man disease it will continue to spread unchecked in the other social groups.

Anne I understand your dismay at discussing sex with your doctor.  This should not be a taboo subject or “uncomfortable” 

Although patients are more likely to test when their physicians suggest it many physicians do not do so because pretest counseling takes considerable time and discussing sexual and drug behaviors that risk transmission may be uncomfortable.

Again I think the “uncomfortable” refers to the pretest counseling and linking a patients sexual or drug habits to the risk of transmission of HIV.  Again we are back to the stigma and stereo typing that HIV is a disease of the poor, indigent or social out cast.  Making the HIV test as routine as any other blood work can only help to diminish these stigmas and stereo types.  Counseling should be done upon the request of the patient  i.e. asking if they have any question and answering them should suffice.  On the same token post test counseling should be done only on an as needed or requested basis.  Most people are better informed about HIV than they let on, as my ID doctor told me today as we were discussing this very subject.  Of course referrals to ID clinics and HIV resources should be readily available and freely accessible.
Mikey

Offline Iggy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #106 on: October 19, 2007, 01:06:09 PM »
Making the HIV test as routine as any other blood work can only help to diminish these stigmas and stereo types.  Counseling should be done upon the request of the patient  i.e. asking if they have any question and answering them should suffice.  On the same token post test counseling should be done only on an as needed or requested basis.  Most people are better informed about HIV than they let on, as my ID doctor told me today as we were discussing this very subject.

Mike,

I think you are not being realistic and in fact are ignoring points repeatedly brought up to you and others with this rationale.  Do you really equate being diagnosed with HIV as routine as being told you have high cholesterol?  I know that is not what you said exactly, but checking someone for cholesterol is an example of a routine blood test.  Does my example not show you the danger in minimizing this test into that category?

After all, Mike, if this was just a routine virus with no long term physical, mental and sociological effects on those with it, how do you explain your own need to participate in these forums or your own myspace profile which needs to make HIV the centerpiece of your profile or the very group you yourself started for yourself and others with HIV?

Now I would surmise that you would suggest that all the above exist for you and others to deal with HIV, to educate and to counter existing stigma by bringing it into the light or bringing it into the open - and I would applaud you, but I would also have to tell you that the very act of needing to bring it into the light or open is contrary to the arguments you have made so far.

Frankly I am amazed you made your last post after this thread was already out:  http://forums.poz.com/index.php?topic=16404.0 These are people who have gotten their results yet years later are suffering from stigma.   I know your argument, but I would like to see some backing for your argument such as some studies showing people who have been tested without counseling and who feel they didn't need to discuss and deal with it and are not suffering any stigma. 

Now your idea that counseling is provided for those who ask for it is frankly unbelievable logic at best, and denies the reality that upon receiving their diagnosis most people can attest to being in anger, denial, shock, despair, but rarely calm indifference and able to make the most rationale conclusions.  In my mind it is like asking who was injured in a car crash if they really need medical care.

And as far as what you and your doctor talked about - Yes, I agree that most of us who have the virus and deal with it everyday can at times be flabbergasted that people don't yet have a clue, but may I suggest you spend some time in the Am I Infected? forum before you come to such a steadfast view of others knowledge of HIV?   Now, If you don't want to accept anecdotal evidence, then try the Terrance Higgins Trust study issued this summer which had one amazing finding: "Almost a quarter of them (18-24 year olds) believe that condoms have holes in them which let HIV through. "  http://www.tht.org.uk/mediacentre/pressreleases/2007/july/july4.htm And keep in mind that the UK is much more ahead of the U.S. when it comes to sex education and discussing condoms in the classroom.

Finally, if all that is not enough, why don't you take a look at the WHO/UNAIDS March 2007 report on Testing guidelines which stipulates the following on their testing guidelines:

 
Quote
Other key WHO/UNAIDS recommendations for provider-initiated HIV testing and counselling in health facilities include:

    * Pre-test information and post-test counselling remain integral components of the HIV testing process.

    * Patients should receive support to avoid potential negative consequences of knowing and disclosing their HIV status, such as discrimination or violence.

    * Testing must be linked to appropriate HIV prevention, treatment, care and support services.
  http://www.who.int/mediacentre/news/releases/2007/pr24/en/index.html

You may disagree with all that is said here Mike, but I do wish you would respond with some studies or concrete rationale to back up your arguments cause frankly I feel that you have been simply talking around what people here have posted vs. actually responding to the direct points.  While I respect your opinion, I think it's time for you to show what actually got you to form that opinion vs. just to keep repeating it.

« Last Edit: October 19, 2007, 01:12:35 PM by Iggy »

Offline mike in VT

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #107 on: October 19, 2007, 06:16:03 PM »
I would like to directly address some statements by Iggy;
  I know your argument, but I would like to see some backing for your argument such as some studies showing people who have been tested without counseling and who feel they didn't need to discuss and deal with it and are not suffering any stigma.
I don’t know where this came from, but it did not come from my last post.   At least I don’t see it in the 656 words of my last post.  I did not say that people who do not receive pre or post test counseling do not suffer stigma.  Thus I have NO need to provide proof of something I did not say.  I have not said or suggested that counseling should be done away with, what I did say is,  Counseling should be done upon the request of the patient  i.e. asking if they have any question and answering them should suffice.  On the same token post test counseling should be done only on an as needed or requested basis.  Clearly what I have said, and what you suggest I was saying are as different as night and day.

Now your idea that counseling is provided for those who ask for it is frankly unbelievable logic at best, and denies the reality that upon receiving their diagnosis most people can attest to being in anger, denial, shock, despair, but rarely calm indifference and able to make the most rationale conclusions.  In my mind it is like asking who was injured in a car crash if they really need medical care.  This summarization shocks me.  Anyone who is injured in a car accident has every legal right to refuse medical care.  Unless they unconscious or are not lucid any one can refuse treatment.  Just because one may be in shock, denial, despair or angry does not preclude them from making rational conclusions as to their own personal needs or desires for medical care.

After all, Mike, if this was just a routine virus with no long term physical, mental and sociological effects on those with it, how do you explain your own need to participate in these forums or your own myspace profile which needs to make HIV the centerpiece of your profile or the very group you yourself started for yourself and others with HIV?  First off I have never said that HIV was a routine virus with no long term effects.  However seeing that you have brought this up perhaps it’s time that I do mention that an HIV+ test result is no longer the death sentence it once was 20 years ago.   People can live full lives with HIV  This is not an opinion it is a medical fact.  Those who continue to treat HIV and act as if it is a death sentence are contributing to the stigma.  This not to say HIV is not serious but it’s prognosis is far more hopeful than it has been in the past. 

Lastly
Do you really equate being diagnosed with HIV as routine as being told you have high cholesterol?  I know that is not what you said exactly, but checking someone for cholesterol is an example of a routine blood test.   Your right that is NOT exactly what I said.  However, so many seem to like to use that example I find it only fitting to point out that, “Your blood cholesterol level has a lot to do with your chances of getting heart disease. High blood cholesterol is one of the major risk factors for heart disease. A risk factor is a condition that increases your chance of getting a disease. In fact, the higher your blood cholesterol level, the greater your risk for developing heart disease or having a heart attack. Heart disease is the number one killer of women and men in the United States. Each year, more than a million Americans have heart attacks, and about a half million people die from heart disease.
http://www.nhlbi.nih.gov/health/public/heart/chol/wyntk.htm#risk
  Surely you can not deny that a heart attack or death is not a life altering condition.   Just for the record I have never equated getting a positive HIV test result with finding out you have high cholesterol.  However lets not diminish the seriousness of having high cholesterol.
 I see the CDC’s recommendation to make HIV testing “routine” as a way to make testing easier for doctors and for patients.  Through this there will in fact be more cases of HIV diagnosed.  When a truer number of HIV cases can be identified there will be a stronger urgency for more research into finding better ways of treating it and even finding a cure.  How can this translate to a bad thing.  In the process many people will find out that they have HIV who would not have know until they became very ill.  They can seek treatment sooner and live longer lives. They will also know their status and be better able to protect themselves and others.  Again I ask how can this translate to a bad thing.
Mikey

Offline David_CA

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #108 on: October 19, 2007, 06:52:05 PM »
Pre- and post-HIV counseling have their places.  We obviously know of the benefits of counseling when an individual tests positive.  How about when they test negative?  Isn't that a good time to discuss how to stay negative, to explain the basics of HIV transmission, and to discuss the consequences of testing positive in the future?  The cholesterol argument isn't really comparable.  "Your cholesterol is fine.  Now, do you know how to keep it low?  Do you know how high cholesterol can cause problems?"  That's silly, unless one has had issues with it in the past.  As to negative HIV test counseling - "Your HIV test came back negative.  That's good.  Now, the important thing is to keep you negative.  Do you know the basics of HIV transmission?  ...."  It all seems really basic to me.

David

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Offline mike in VT

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #109 on: October 20, 2007, 10:06:58 AM »
Hi David
I would agree that these are good times to discuss these issues.  As the current mandate goes these are things that “MUST“  be discussed pre and, or post testing.
  At this point I would like to point out just a few things about the recommendations that may have been misread.
Now the recommendation state the following;
"These revised recommendations update previous recommendations for human immunodeficiency virus (HIV) testing in health-care settings and for screening of pregnant women (see "Guideline Status" field). Major revisions from previously published guidelines are as follows:
For patients in all health-care settings
•   HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
•   Persons at high risk for HIV infection should be screened for HIV at least annually.
•   Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.
•   Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings."

Granted this is just the very first part of the recommendations none the less they are very important points.  These recommendations would and do allow for HIV to be treated more like any other STD as far as testing goes.  "Prevention counseling should not be Required..."  should not be Required, being the key words.  The same goes for special consent forms.   The phrase “should not be required” dose NOT mean “Shall be eliminated”  As these “special consent forms” and “counseling” are directly linked to funding at this time, recommendations such as this will help to open the door to more people being tested without clinics and other medical settings loosing their funding.  It also leaves the door open to counseling for those who need or want it.  I personally would hope that any Doctor would discuss what the tests results mean to a person be it an HIV test or any other test.
Mikey

Offline Iggy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #110 on: October 20, 2007, 10:23:17 AM »
Mike,

I feel you and I will go in circles and I don't think that helps the issue.

I accept that we see this issue differently and feel comfortable that in my discussion with you that my previous posts repeatedly and clearly outlines the errors in your thoughts and logic on the issue, while clearly supporting my point with clear and basic logic and  backing from studies and points stated by recognized leaders in the fight against HIV and world health organizations. - Frankly I don't think one can get clearer that the World Health Organization and the UNAIDS saying that pretest and post testing counseling must go hand in hand with testing...

I hope someday that you can grow in your understanding of the issue to appreciate what I have said in regards to this issue.

Pre- and post-HIV counseling have their places.  We obviously know of the benefits of counseling when an individual tests positive.  How about when they test negative?  Isn't that a good time to discuss how to stay negative, to explain the basics of HIV transmission, and to discuss the consequences of testing positive in the future?  The cholesterol argument isn't really comparable.  "Your cholesterol is fine.  Now, do you know how to keep it low?  Do you know how high cholesterol can cause problems?"  That's silly, unless one has had issues with it in the past.  As to negative HIV test counseling - "Your HIV test came back negative.  That's good.  Now, the important thing is to keep you negative.  Do you know the basics of HIV transmission?  ...."  It all seems really basic to me.

David



David - Thank you. 

You reiterated what I have said in my previous posts very well and that which is continuously seems to be lost by those who do not understand the counseling as a necessary requirement to go hand in hand with testing. 
Quote
I'm certain you must realize that someone getting a diagnosis of being neg today is not conclusive of whether of not they are neg at the time of the test results and has nothing to do with their status at the time of the test results if they engaged in any risky behaviour since testing.

It's not if people will or won't use condoms because of a test result saying they have HIV, it is if people understand what a test result does mean and doesn't mean whether it says they are HIV positive or negative and then acting erroneously because of lack of education and counseling....

Quote
We continue to see on this board how many people become embolden to continue having unsafe sex simply because they got a neg result...and yet as we all know a neg result doesn't necessarily mean one is neg, now does it?

So to your statement that State Laws are contributing to the Spread of AIDS because of counseling requirements - I ask:

Would you not agree that implicit in telling people that they have a neg result is counseling them and educating them on what the result means and what it doesn't mean and how to avoid risking themselves or others? 

I truly find it very disheartening that anyone would feel the need to make an argument against tying education and counseling to testing.  Thank you for getting it.

Offline next2u

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #111 on: October 22, 2007, 01:37:16 AM »
aiight, im gonna have to side with wes on this one. this thread is damn long, but it's a good fucking read. that pre/post counseling notion is crap. for me it was a signature on a piece of paper and a phone call from my apologetic doctor two weeks later. is counseling good, yes, does it matter - sure. but just reading that form is different from knowledge and experience. just cause someone reads something on a form doesn't mean they will understand it, especially if they have no relative experience to the subject. on my consent form there was a statement about discrimination and how a positive result could compromise the quality of life... that's all true, but it doesn't change my fucking status and it sure not gonna help someone who can't relate.

having routine testing and reducing hurdles to these tests is a great idea. preparing someone for how individuals and society is going to react, that's a rather daunting task and i don't feel it should be shouldered entirely by the heathcare community. media, government, educational institutions, and other civil infrastructures should pitch in. reading about discrimination and tackling it are two different tasks, and i don't think a consent form or the 15 minute slot given by any hmo adequately addresses the issue - so fuck it, test them and lets work on the problem comprehensively. testing and knowing is more important. emotional/mental damage will happen sometimes, but getting into a program, whether underfunded or a bureaucratic nightmare, is more important. and if the program isn't there, the person who is poz is now in an informed position and can begin looking for other options.

yes, funds are dwindling and healthcare may be out of reach for some, but knowing ones status is crucial to the preservation of self. if i hadn't requested the test i never would have found out. hiv testing is not routine at my doc's. even though i am in a high risk group my docs never suggested that i test. when i seroconverted i saw two different doctors who both misdiagnosed me. i had to request the test myself, and yes, they knew i was sexually active. now my numbers appear low and lord only knows how much worse things would be if i hadn't found out. then it took over a fucking month just to get an appt with an id doc after my diagnosis.

if someone is gonna go off the deep end, a pre/post consent or counseling form is hardly gonna stop them. a loving family, decent education, access to resources, great peeps like here in our poz community, and hope will produce comparable or better results than a consent or counseling form.

information is needed for change. that information can only be obtained from a test. hopefully the numbers will encourage greater distribution of knowledge & supplies (condoms, needles). okay, im sorry for being an ass, but i think the counseling should happen presex, not pre/post test, but we all know this isn't a perfect world. and yes, i spent an inordinate amount of time on the counseling/consent forms. they just peeved the hell out of me.   
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Offline Iggy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #112 on: October 22, 2007, 10:07:15 AM »
aiight, im gonna have to side with wes on this one. this thread is damn long, but it's a good fucking read. that pre/post counseling notion is crap.

Amazing summary rejection of what people in the field, educators, activists, studies and what is witnessed in the AM I infected forum everyday have repeatedly demonstrated. 

Unfortunately I think you (and many) completely miss a vital point in this debate that makes your pronouncements a little premature, and very foolish.

The error in your argument lies in your take on the situation based on your individual experience - in other words: your subjective view on what it means to YOU.  You make pronouncements of the good and the bad, vital and useless, important and unnecessary, solely on the effect it has with you and on your own knowledge of life.  Unfortunately in order to actually understand problems and solutions in the matter of curbing the spread of HIV infections for everyone, you need to broaden your point of view to understand that not everyone is you, and you should not be dictating what is or isn't required for the masses whether or not you think it is something worthy of your personal time. 

In other words, when you say things like this:
Quote
If someone is gonna go off the deep end, a pre/post consent or counseling form is hardly gonna stop them. a loving family, decent education, access to resources, great peeps like here in our poz community, and hope will produce comparable or better results than a consent or counseling form.

I need to ask you why you would reach with the assumptions that everyone has a good family, decent education, have the ability to have a positive outlook, access to resources or even know people in the community as being a viable alternative to making sure that at the time of the test that every individual has mandated direct access to a counselor who can in fact provide them the connection to support groups and realistic, practical and factual information about their diagnosis?

Also the moral judgments of the value of family, education and optimistic (perhaps spiritual?) outlook is a deterrent to helping and reaching anyone who doesn't fall neatly into such pigeonholed categories.  Perhaps you do not even recognize this, but your above argument that I highlighted is not far at all from those who would deny funding for condoms, distribution of clean needles, and sex education in the classroom simply because they feel that HIV prevention is a matter of morality and personal choice and not simply a virus and something that requires government involvement.

Frankly I just don't understand the rationale that because it doesn't seem necessary to one that they have the right to deny it being provided to others.

One last thought to consider in your argument and something I've yet to see addressed by any who would do away with counselling requirements:  Many of you are making your argument that a key way to combat HIV and stop the spread of new infections boils down to an issue of providing all people with important and vital information:  The information of their HIV status.  A good and rationale idea, and I might add, one that I agree with.  However ask yourself how one can honestly make a such an argument by stating that we must only focus on the selective information (the test result) at the cost of complete information (what that test result actually means and how to avoid infection - whether infected yourself or another)? 

I personally don't see it as possible nor logical -  at least not without hypocrisy.



Offline Iggy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #114 on: October 22, 2007, 10:23:45 AM »
Knowledge is power.

http://www.washingtonpost.com/wp-dyn/content/article/2007/10/21/AR2007102101368.html

From the article:
Holbrooke is also correct to emphasize the importance of HIV testing, especially for providing the main gateway into treatment. There is, however, little evidence that knowing one's HIV status fundamentally alters behavior. A few studies have found some modest changes in behavior among those who test positive, but most trials unfortunately show that people who discover that they are not infected with the virus continue acting as they did before being tested -- despite the obvious danger to themselves and to others.


Thank you Hal!
« Last Edit: October 22, 2007, 10:38:23 AM by Iggy »

Offline woodshere

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #115 on: October 22, 2007, 11:05:31 AM »
•Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings."[/color]

Don't you think someone who tests negative needs to be told that if they have engaged in unsafe sex during the past 3 months that they could have become infected and it not show on the their HIV+.  Therefore this happens:

There is, however, little evidence that knowing one's HIV status fundamentally alters behavior. A few studies have found some modest changes in behavior among those who test positive, but most trials unfortunately show that people who discover that they are not infected with the virus continue acting as they did before being tested -- despite the obvious danger to themselves and to others.

I personally would hope that any Doctor would discuss what the tests results mean to a person be it an HIV test or any other test.

And I would hope that Bush would realize his mistake and get us out of Iraq.  Doctors of large practices hire consultants to tell them the best way to make money. They need to see x number of patients in x amount of time, meaning they need to spend 6 minutes per patient.  Not much time for counseling.  When I told my doctor I wanted to take the HIV test as part of my routine physical he said fine and checked it on the form.  I was notified 2 weeks later on the phone at work.  He told me I was poz, it wasn't as bad as it used to be and that his office would make a referral.  That was it.

.... if the program isn't there, the person who is poz is now in an informed position and can begin looking for other options.....
.... a loving family, decent education, access to resources, great peeps like here in our poz community, and hope will produce comparable or better results than a consent or counseling form.

I am not sure what to make of these two statements, they just smack of someone who has all of these things and is completely unaware of the problems those who don't have them encounter. 
"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it."   Nelson Mandela

Offline next2u

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #116 on: October 22, 2007, 10:36:06 PM »
I don’t expect anyone to read all this gibberish, but here it goes.

Look igg-meister,

You are one hell of a thinker and raise a shitload of great points. With that said, your points fail to miss a crucial aspect my post, that we cannot lay the entire responsibility of support/understanding/counseling on medical institutions. These changes need to be cradled by multiple facets of our society.

My personal hmo experience has been echoed by others – shitty hmo’s. a signed consent form, an impatient doctor, an overbooked nurse – where’s the rarity in this situation? It happens all the time. Yes, it would be fucking wonderful if a dr and psychiatrist sat down, held our hands, on told us the world would be different. Unfortunately docs don’t have that much time, and lengthy therapy sessions in a hospital aren’t viable.

My assessments about knowledge being crucial has two aspects. one – the person receiving the information may not be able to process it, regardless of the form it is in. also, having an understanding of something is far different from experiencing it. Secondly, to have the information of one’s status lets a person actively decide to deny or accept it. Hey, im not saying this will work for everyone, but I do believe the majority of informed people will take necessary steps to preserve self, it’s some type of biological imperative.

As for my assumptions (and yes, I am answering you point for point, you have the mental wheels cranking) – I did not assume we all had this wonderful resource pool. I was trying to show that other factors can have influence on a newly diagnosed person. In the case of anonymous testing, or my hmo, pozzies receive phone calls or quickies. For patients whose dr’s make them come in great – but the newly diagnosed have to leave that doctor and that is when the other support is necessary. If someone does not have access to these resources, hopefully they can begin a search for some. As I said earlier, it is still better to know because the person can begin looking for ways to take care of themselves. Be it at a library, through a friend, a gay center, the internet, an aids hotline, or a drastic move, a determined soul can find a means to survive. And I did not say this would be easy – just more pertinent if a person knows their status.

Do I think counseling forms are pointless, no, but in many cases they are ineffective. Reading about the possibilities and experiencing them are vastly different.  I just don’t understand how a written statement about discrimination is gonna help someone. Or how a brief sentence on depression is gonna make a difference. If these things were more comprehensive that’d be great. But they are not- and it’s almost fucking laughable. we know from the stigmas in society how people will  react. disease brings shame, creates pariahs, makes us whores. that shit ain't on a fucking counseling form, its part of the cultural inculcations that have been happening since birth. since these thoughts are not supported by the hospital, i don't feel it's the hospitals sole responsibility to address them.

And exactly why I am being faulted for mentioning a comprehensive solution as superior to a brief document? Family, friends, networking, etc… are great fucking support. My counseling document didn’t say things will be shitty, but with meds and support you can get through this. The people here told me that. My support group told me that. My friends, literature, etc helped me through this. My doc though my insurance company? He told me I might have 10 years to live. Great fucking document, great fucking doctor. And yes, I do (did) pay him for his advice. 

And no where in my entire response did I advocate removing counseling. I simply believe consent forms/counseling forms are not the best way of helping someone transition or prepare for the new life they will be facing. Especially not in the settings ive read or heard about. I remember signing those shiznits at the co dept of health, there wasn’t a soul there to talk to. The form was even shorter and the staff was antagonistic. Where the fuck do I get off sounding like an optimist?

Uggh, this is gonna go on forever and I don’t wanna burden the thread with this longass circuitous response. Man, I went off on an aspect of the problem. Revealing someone’s status is important, but prevention information is exceptionally important also, hence the presex conversation line. And if someone is positive, hopefully they will do what they can to prevent infection. Like, you can take a horse to water but you can’t make her drink.

Lastly, mr woodshere (im loving your profile pic), yes, I do have some of those things. My dad passed away last year (ive seen him two times since I was 14), my stepdad calls every 6 months, me and my mom fight every time we talk, I have access to resources cause my credit debt is astronomical, but I get the best support here. Anyone can access this forum. Now, let’s not get into a debate about the digital divide, class or status. I am not saying everyone has access to the same resources, I am saying that knowing ones status will increase the desire to access these resources in order to preserve self.

And for you iggy, they didn’t even let me take the fucking counseling form home. yes, I am being subjective, but everyone is subjective and the only people who don’t believe so are fucking lying to themselves. We understand the world from our personal experiences and grapple with life based on our paradigms. You can produce stats that can support your arguments and so can I, so what makes your stance more legitimate? I like talking in first person and being subjective. As far as im concerned distancing myself from this argument is a luxury I can’t afford.   
midapr07 - seroconversion
sept07 - tested poz
oct07 cd4 1013; vl 13,900; cd4% 41
feb08 cd4  694;  vl 16,160; cd4% 50.1
may08 cd4 546; vl 91,480; cd4% 32
aug08 cd4 576; vl 48,190; cd4% 40.7
dec08 cd4 559; vl 63,020; cd4% 29.4
feb09 cd4 464; vl 11,000; cd4% 26
may09 cd4 544; vl 29,710; cd4% 27.2
oct09 cd4 ...; vl 23,350; cd4% 31.6
mar10 cd4 408; vl 59,050; cd4% 31.4
aug10 cd4 328; vl 80,000; cd4% 19.3 STARTED ATRIPLA
oct10 cd4 423; vl 410 ;); cd4% 30.2
jun11 cd4 439; vl <20 ;); cd4% 33.8 <-Undetectable!
mar12 cd4 695; vl ud; cd4% 38.6
jan13 cd4 738; vl ud; cd4% 36.8
aug13 cd4 930; vl ud; cd4% 44.3
jan14 cd4 813; vl ud; cd4% 42.8
may14 cd4 783; vl *; cd4%43.5

Offline Iggy

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #117 on: October 23, 2007, 08:55:21 AM »
Thanks Next,

I'll try my best here:
And no where in my entire response did I advocate removing counseling. I simply believe consent forms/counseling forms are not the best way of helping someone transition or prepare for the new life they will be facing.
You did right here: 
aiight, im gonna have to side with wes on this one. this thread is damn long, but it's a good fucking read. that pre/post counseling notion is crap.
Besides saying you agree with Wes - who is advocating the removal of counseling requirements as he sees it as the barrier to mass testing... you point blank said that pre/post testing is crap.

If you meant something different then so be it - but what you said in the post and I responded to was clear.

Quote
And exactly why I am being faulted for mentioning a comprehensive solution as superior to a brief document?
Because you seem to still not recognize that what is deemed superior by you is not superior (or even available for) to everyone.
 
  • Not everyone has a great family - in fact there are many here who can tell of being abandoned by family. 
  • Your point about a decent education is not logical - did a decent education keep anyone from contracting the virus to begin with? 
  • The hopeful outlook that you suggest is a little laughable when you consider that a person who is getting a diagnosis of being HIV infected rarely has a first thought of looking for a silver lining.
  • And suggesting that the people in the community are a better alternative to information than a doctor's office is partially true, though wonder if you think that people just automatically know where to find them....and keep in mind not everyone is an internet master or lives in a urban community.

That is why I fault this line of thinking of you here - not because you find strength in such items (actually I applaud you for that) but you trying to make a case that because it works for you then that is reason to assume it will work for anyone else...and that is exactly what you are doing when you suggest it as a viable alternative to universal access to a counseling at the time of testing.

Now I do agree with you that counseling as just a form to be read and signed doesn't cut it - I agree 100% But I don't think the solution is in just saying we abandon counseling. If that was the case than we might as well abandon any outreach.

As far as you stating doctors and nurses are overworked to begin with and should not be burdened with counseling  - I partially agree.  I disagree that  to discuss the medical facts of a virus and what it means to the infected person is outside the scope of their job...on the contrary - that is in fact the very point of their job - however I do feel that most of the doctors and nurses today are in fact burdened with paperwork that keeps them from having the time to actually do that job. If you wanted to write a diatribe about the insurance industry (who might I add is a party with deep pockets who are one of the lobbying parties trying to fight the counseling requirements) then I am right there with you, but I don't consider counseling with test results a burden to the medical community. 

What I think is funny (in a very sad way) is how many people don't realize that when they rail against the counseling requirements by citing paperwork  burdens to the medical community they do not realize they are in fact just promoting a pr line put out by the insurance community who certainly has no issues with a doctor's paperwork burden -  as long as it is in regards to processing payments, of course.

I think a problem here is that you and many misunderstand the notion of counseling in the context of testing because of the bastardization of the meaning of the word by American self help movement.   Counseling is not hand holding, feel good sessions or tributes to teary eyed moments of a Lifetime movie.  Counseling in relation to testing (or general medical situations) is the providing of facts and resources in understanding and dealing with the medical situation - something that is intricate to the medical professionals job. 

I fail to comprehend why that is an issue for anyone to debate. 
 

Offline woodshere

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #118 on: October 23, 2007, 09:20:34 AM »
Lastly, mr woodshere (im loving your profile pic), yes, I do have some of those things. My dad passed away last year (ive seen him two times since I was 14), my stepdad calls every 6 months, me and my mom fight every time we talk, I have access to resources cause my credit debt is astronomical, but I get the best support here.


Next2u, I must apologize, I made a sweeping uninformed judgement, that was out of order.  

A statement such as this:

Anyone can access this forum. Now, let’s not get into a debate about the digital divide, class or status. I am not saying everyone has access to the same resources, I am saying that knowing ones status will increase the desire to access these resources in order to preserve self.
 is just as sweeping and uninformed as mine.  When discussing HIV or for that matter any medical situation you cannot just disregard class or status.  They play a vital role.  You are correct that anyone regardless of class or status can walk into a public library and gain access to a computer provided they have a library card.  Of course when you are homeless you don't have a permanent address to list which might prohibit you getting a card.  But for discussion sake let's say this homeless person gets access to a computer.  It is difficult to use a computer if you dropped out of school 30 years ago and have never even used one.  But fortunately instructions are available, too bad you read at the first grade level if at all.  Someone who is living in poverty, most likely has very little education and is on the bottom rung of the "status ladder"  faces obstacles that you and I can handle but for them they get lost.  And when one is lost the desire to preserve self is likely to be lost also.

Now don't get me wrong knowing ones status is very important.  But if these basic problems are not addressed the spread of HIV and Aids will not slow thanks just to routine testing.
"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it."   Nelson Mandela

Offline next2u

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #119 on: October 24, 2007, 01:05:51 AM »
woodshere - iggy, you two are great :)

this will be taken up again at a later time (i have a lot excuses). wow, you two won't let me out easy on this one. iggy, good definition on counseling. stop negating my points, you are making it hard for me to keep up. woodshere, my statement was too sweeping - damn it. hmm, i guess its not worth debating if you all don't put up a good resistance. but without the debate their is no growth. while i still don't agree with you 100%, i have changed my viewpoint.

and iggy's pic is adorable too : )

but seriously, state laws are fucking us. to be continued...
midapr07 - seroconversion
sept07 - tested poz
oct07 cd4 1013; vl 13,900; cd4% 41
feb08 cd4  694;  vl 16,160; cd4% 50.1
may08 cd4 546; vl 91,480; cd4% 32
aug08 cd4 576; vl 48,190; cd4% 40.7
dec08 cd4 559; vl 63,020; cd4% 29.4
feb09 cd4 464; vl 11,000; cd4% 26
may09 cd4 544; vl 29,710; cd4% 27.2
oct09 cd4 ...; vl 23,350; cd4% 31.6
mar10 cd4 408; vl 59,050; cd4% 31.4
aug10 cd4 328; vl 80,000; cd4% 19.3 STARTED ATRIPLA
oct10 cd4 423; vl 410 ;); cd4% 30.2
jun11 cd4 439; vl <20 ;); cd4% 33.8 <-Undetectable!
mar12 cd4 695; vl ud; cd4% 38.6
jan13 cd4 738; vl ud; cd4% 36.8
aug13 cd4 930; vl ud; cd4% 44.3
jan14 cd4 813; vl ud; cd4% 42.8
may14 cd4 783; vl *; cd4%43.5

Offline mecch

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #120 on: October 01, 2008, 04:40:46 PM »
I strongly disagree. ....  IF the government agreed to guarantee treatment to people with HIV, then I think streamlined testing makes sense.  But in the present climate of private healthcare, where insurers are desperate to find ways to exclude people from coverage, I worry that HIV tests without consent would contribute to discrimination against people with HIV. 

I am in Koksi's camp on this one.  Mandatory HIV testing - great for controlling the epidemic -- still only makes sense in a country that commits to universal health care.  See K. Marx's mandate, below....
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline hivsweden

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #121 on: October 01, 2008, 05:28:46 PM »
[Removed] Did not notice thread was old until Sharkdiver pointed it out.
« Last Edit: October 01, 2008, 06:21:07 PM by hivsweden »

Offline sharkdiver

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #122 on: October 01, 2008, 06:11:37 PM »
This thread is almost a year old.  And, some members who posted on it and started it are no longer part of this forum . If you think it is an important topic, it would probably be a good idea to start a new one.

Offline sharkdiver

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Re: State Laws Are Contributing to the Spread of HIV and AIDS
« Reply #123 on: October 02, 2008, 12:12:31 AM »
Figaro,

I understand your passion behind the needle exchange, but you aren't POZ. 

 


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