This makes no freaking sense

[Almost2late]

This really makes no sense that this very blue state with 5000 new infections a year, the Governor would veto a bill that would allow ER's to "offer" HIV testing.. If my state would have offered me testing the several times I've been to the ER before my dx, I would not be living with an AIDS dx.. So fuckin stupid.. Thought this Brown was a liberal..

http://patch.com/california/southsanfrancisco/governor-vetoed-bill-requiring-hiv-test-be-offered-ers

[leatherman]

I don't often side with AHF but they are right to blast back. this is a very sad situation.

I've always believed that opt-in testing, that isn't even offered, has been a huge gap in our prevention/early detection interventions. I can't tell you how many people I know who went through multiple ER and hospital stays without a doctor even suggesting, much less just running, the test. Many people have presented with basic symptoms and during the search for the cause not understood that no hiv test was run. Unless YOU know to ask, no one even offers. Many people (sounds like you're one of them A2L) just assume they were "tested for everything" and assume that since no one said the problem was HIV believe that HIV isn't the problem - until later when things are even worse.

that "no-one-to-counsel" excuse is lame. Lots of people have been diagnosed and gone on with no one ever counseling them. Hell, no one counsels the people who use the home test either.

[Jeff G]

UAB in Birmingham now offers testing to all people admitted to the hospital as a standard practice but you can opt out if you want.

I wish there was more of a push to make testing more a routine test so that its just part of any physical but there is that little issue of access to treatment that must be addressed too if we wish to get on the test everyone bandwagon. I think Jerry Brown got this wrong in a big way.   

[LukasAtlPZ]

I think that the hospital should always perform HIV and Hep testing whenever performing ANY invasive procedure/surgery (either out-patient or in-patient). Testing should also be SOP in the ER, based on common sense of course.

[leatherman]

UAB in Birmingham now offers testing to all people admitted to the hospital as a standard practice but you can opt out if you want.

I wish there was more of a push to make testing more a routine test so that its just part of any physical but there is that little issue of access to treatment that must be addressed too if we wish to get on the test everyone bandwagon. I think Jerry Brown got this wrong in a big way.

I should have pointed that out!! I usually do.

I don't remember exactly when (2011 or so I'm thinking. It was around my first yr of being commchair for the task force and I posted something on our website about it. google it up if you just have to know. LOL WooHoo! My brain is hanging in there. 2011 was the right year http://www.infectioncontroltoday.com/news/2012/08/first-year-of-hiv-testing-in-uab-ed-helps-reduce-the-spread-of-virus.aspx) but a few years ago, ADPH was the first state to approve opt-out HIV testing in emergency rooms. that was an incredibly farsighted move on part of the health department in a state with very "red-state problems". (Hey! I ain't ragging on AL cause SC ain't much better. The third-world HIV epidemic levels of testing, treating, and deaths across the South is just appalling considering I'm chatting via the internet while living in a very much first-world society.)

as to the reasoning about a lack of counseling in an ER testing situation, that stills sounds so senselessly shallow to me. ERs are often attached to hospitals. Surely there must be some sort of counselor on-call to deliver all those other horrible bits of bad news to people who are dx'ed with all sorts of other deadly problems. And for the non-affiliated ERs, they're probably telling people a bunch of bad news and even telling accompanying family and friends that patients have actually died, not just been infected with a terminal, but treatable, illness.

using mental health as a barrier just shows, to me the PLWH advocate, that we need more access to mental health care for people, especially for people diagnosed with HIV since there seems to be so many issues related to diagnosis, living with, dealing with, and living a long time with HIV. As a highly involved LTS, I can clearly see that mental health care is needed on either extreme of being newly diagnosed or as a long term survivor; but the expectation is too high if only those with access to counseling should be the ones to get access to testing.

[leatherman]

but there is that little issue of access to treatment that must be addressed too if we wish to get on the test everyone bandwagon.

without diminishing the whole aspect of this huge issue, I would like to say something about the scope of the issue. you know, a little insider-talk. I know the adap waiting lists are hardly ancient history (those were just cleared back in 2011/2012) but these days, thanks to a lot of creativity from state-run ryan white programs, we're getting a lot more people into treatment a lot easier. Even the change from starting"meds @ 350" to "starting @ diagnosis" is partially supported because we are getting those tested into treatment these days, and quickly into treatment. Even HRSA HAB measures have been bumped up pushing quality improvement.

while the national care continuum looks like this:


at many individual ASOs, their care continuum looks much different.
for this graph below (my own just-now pasted-together creation thank you. LOL) the client is defined by someone who has HIV, has been diagnosed, and has been linked to care. That's a lot of steps in the national continuum that are just breezed through sometimes - especially, say, at an ASO or FQHC (federally qualified health care) where a testing positive could lead to an immediate doctor visit with ARV prescription.

For example, at my ASO we worked through a quality project to review the time from diagnosis to medical visit (with now includes prescription). We improved that number from 21 days to 4-7 days! Several other agencies around the state have very similar numbers; although 8-12 seems about the average.


of course, retaining clients in care is the bug-a-boo, however once that happens we have 100% ARV prescription and usually high levels of viral suppression. I also think this chart could look like 100/85/100/75, a kind of up-down up-down flow, and be just as accurate. Regardless, we know that that there is a great function to show that more linkage equals more viral suppression.... in the long run. 

[Jeff G]

I cant wrap my head around why the state of Ca. thinks its sound reasoning to not fund a test for a life threatening condition . Its like admitting defeat and throwing hands up and saying that treatment and testing is a pipe dream and something that the medical community cant handle . What kind of message does this send to people on the fence about testing ?

[Almost2late]

I agree that counseling would be ideal after an HIV diagnosis but come on, do you want to save some lives and stop an infected person from spreading this or not?..

Can't help but think that Governor Doo-doo Brown had his hand held out and someone forgot to grease it, which is what usually is going on in these situations when politicians come up with such ridiculous excuses..

Really? Alabama got this done!.. Wow, that's good.. How many other states?

[Jeff G]

Really? Alabama got this done!.. Wow, that's good.. How many other states?

It was not a state initiative . It’s a policy that UAB health Systems and UAB hospital adopted to help get people diagnosed and into treatment.