I think it is a good idea.Could you elaborate. I mean if I am unconscious or unable to communicate, how dare you, if without prior consent, living will etc. do this without permission? This is so wrong in so many ways. I want to state that I think everyone should test and clearly test frequently as these days no one is to be trusted, but to test someone without permission, I don't think so, particularly in this country where you have to fight tooth and nail to get a procedure to just frigging live.
With as many as 25 percent of people with HIV being unaware of their infection and data stating that those on treatment are 96 percent less likely to transmit the virus, infering that the majority of transmission are from those untreated, I agree its a good idea as well.
Not only that, but untreated HIV is dangerous. I am all for people knowing their status. Waiting for someone to decide to test can be too late, for themselves and for those they end up infecting in the mean time. As a matter of public health it seems to be the responsible option.
With as many as 25 percent of people with HIV being unaware of their infection and data stating that those on treatment are 96 percent less likely to transmit the virus, infering that the majority of transmission are from those untreated, I agree its a good idea as well.The responsible option is for people to wear condoms -
Not only that, but untreated HIV is dangerous. I am all for people knowing their status. Waiting for someone to decide to test can be too late, for themselves and for those they end up infecting in the mean time. As a matter of public health it seems to be the responsible option.
The responsible option is for people to wear condoms -
If it is a matter of public health - let's just quarantine everyone with HIV. Hey, while were at it, we should give mandatory vasectomies or "tie the tubes" of anyone who is unwed who has a child. Hey, we could drug test all citizens and shoot the ones who test positive for drugs. Hey, we should also shoot everyone who smokes cigarettes (afterall secondhand smoke kills); shoot those who drink alcohol and neglect their children, cause crashes when under the influence; or don't cover their mouth when they sneeze; sell cholesterol raising fast food.....I'm sure I can think of other public health risks that could easily be solved by removing the responsibility from the person for addressing it and/or avoiding it and shifting the responsibility to the government. Sounds like a great plan ::)
Hey, while were at it, we should give mandatory vasectomies or "tie the tubes" of anyone who is unwed who has a child.
Could you elaborate.
Jesus Titty Fucking Christ. Always with the infecting. ::)
People infect themselves. How many times does this have to be pointed out? If you insist on condoms for anal and/or vaginal sex it doesn't matter if your partner is HIV positive or not.
The inability of so many to take responsibility for themselves is not a reason to undermine fundamental principles of healthcare delivery like informed consent.
MtD
So then the issue becomes one of testing people in emergency departments for HIV. I work in an emergency department and the staff routinely tests patients for various conditions without asking for specific consent. They draw blood and urine and look at any number of conditions: pregnancy, drug use, alcohol intoxication, anemia, influenza, tuberculosis, viral infection, bacterial infection, diabetes, etc. Why should HIV, a virus, be different? What is so special about HIV? HIV can be life threatening. So are a lot of other conditions. HIV is communicable. So are a lot of other conditions. Is it because HIV has a stigma? So does syphilis, herpes, lice, mental illness, etc. but we still test for those. Some argue it is upsetting and life changing to discover you have HIV. Well, so does finding out you have cancer or a brain tumor or a host of other conditions.
What is so special about HIV? Nothing. HIV is like cancer, heart disease and a host of of other conditions that millions of people have, don't know they have and they are going to suffer for their ignorance. Stop perpetuating stigma by putting HIV in it's own special category. It is a virus, a matter of public health and everyone would be better of treating it as such.
What's so special about HIV?
Why should HIV, a virus, be different? What is so special about HIV? HIV can be life threatening. So are a lot of other conditions. HIV is communicable. So are a lot of other conditions. Is it because HIV has a stigma? So does syphilis, herpes, lice, mental illness, etc. but we still test for those. Some argue it is upsetting and life changing to discover you have HIV. Well, so does finding out you have cancer or a brain tumor or a host of other conditions.
What is so special about HIV? Nothing. HIV is like cancer, heart disease and a host of of other conditions that millions of people have, don't know they have and they are going to suffer for their ignorance. Stop perpetuating stigma by putting HIV in it's own special category. It is a virus, a matter of public health and everyone would be better of treating it as such.
If someone doesn't want to be tested they can opt out. If someone is so terrified of being tested for HIV then I suggest they contact their local emergency department and have a list put in their chart of all the bad things they just don't want to know about.
Testing without consent, at the end of the day is just so wrong at so many levels because however you dress it up it is a blatant infringement of one's privacy.
To me this is the equivalent of saying that testing for cancer is an infringement on your privacy. If it found your cancer early enough and saved your life would you still be against it?
To me this is the equivalent of saying that testing for cancer is an infringement on your privacy. If it found your cancer early enough and saved your life would you still be against it?
Spacebarsux, your issue appears not with testing in an emergency department but with testing without consent. In the scenario that Alan described people had the chance to opt out of being tested. If it was policy that unconscious patients would not be tested would you still have an objection?
I may have missed this but if the testing is not paid for by existing ADAP funding how will this cut funding for those currently relying on ADAP? I would argue that by diagnosing infection before CD4 counts hit single digits new patients could begin earlier treatment. This in turn would allow them to continue working and providing their own healthcare insurance. Conversely if we wait until VL hits 1,000,000 copies and CD4 counts reach near 0, we then gain new disabled patients that rely on already underfunded ADAP and other public programs.
What's so special about HIV? Well it's not an acute condition. I can't think of a pressing medical emergency where testing for HIV without the consent of the patient would be a triage priority.Why invent the wheel? There are not many on this site that can so state so clearly how I feel so frequently! Thank you. I am sure there will come a day when we will disagree and you will twist my balls, but until then, cheers!
What's so special about HIV? It's a deeply stigmatised condition and people should have the right to consider the ramifications of testing before it occurs. Not just the social ramifications but the legal consequences as well.
People should have the right to refuse an HIV test should the fancy seize them. Not be subjected to the tyranny of Accident and Emergency staff.
MtD
Knowing one's status without having access to treatment is a recipe for depression....even if the intent is good ---- the road to hell is paved with good intentions.
The consensus seems to be people should not get tested for HIV unless they are emotionally ready to hear a positive results and they have access to treatment.Pretty much agree with this -
Pretty much agree with this -
My biggest concern is the access to treatment part -
Now, there is a philosophy that was used in the drug addiction field and this was that if enough people presented for treatment than that would show the extent of the problem and the powers that be would then increase the amount of funding to make treatment on demand available - unfortunately, we know that this isn't the case.
This may be the line of thought of those implementing this program ---- test everyone, show the amount of people infected, and then the resources will be made available to treat them ---- however, I think we all can see by the number of people who are on ADAP wait lists and struggling to get insurance coverage, that this will not be the case. Instead, with this type of program, thousands may find out they are positive but then not have access to treatment.
Testing with needed emotional and medical support would be the ideal. Testing without informed consent or even with informed consent but without the resources to treat is a recipe for disaster.
I guess I'm too dumb to understand the logic.
How is catching HIV infection as part of consented routine care bad?
If we catch the infection while the immune system is relatively intact, treatment options and costs are significantly better than if we simply wait until the patient presents with an AIDS defining OI.
Regardless of how treatment is funded the survivability goes up and the cost of treatment goes down.
One argument seems to be mental health related. Eventually everyone that is infected will be diagnosed. Would it be easier on the patient[s mental health to wait until he presents with AIDS related complications and then say "Oh, by the way, you have AIDS on top of this Cancer and pneumonia."
My thinking is it would be easier to get a diagnosis of HIV and a reassurance that "We've caught this early enough that your treatment options are good. Immune system is relatively intact and we don't have to worry about OI's at this point."
If treatment costs are the concern, wouldn't it be cheaper to treat the patient with CD4 of 500 and low VL as opposed to waiting until the patient has several OI's and a completely ruined immune system? Those patients with insurance will be treated under their health insurance. Those on public assistance will still need to navigate the system but by catching it before it's a crisis we give them the opportunity to navigate a very broken system.
Ultimately everyone that is infected will be informed they are HIV positive. Everyone that is infected will face the fact that they must enter treatment. Do we have them put their heads in the sand and wait until their infection is at a critical stage or do we try to catch the infection early and treat appropriately?
All valid points of course, but are still trumped by the matter of individual choice. No one should be forced to be tested, regardless of whether you or I agree with their decision.
Ultimately everyone that is infected will be informed they are HIV positive.
Everyone that is infected will face the fact that they must enter treatment.
First sentence, not true. My first husband died not knowing he was infected (the autopsy showed PCP).
Second sentence, not true. The face that they "must" enter treatment, or "should?" Some people will never have the resources or help to get treatment.
OK I give up again. But I'll ask before I go:
How many people die of AIDS without knowing they are infected? I doubt even 1%
Your also right, some people lack the means for treatment. Does this really mean we should not offer routine CONSENTED testing to everyone, at no charge to them, because of this subset of people?
By getting people tested and into treatment early we improve their health and treatment outcome in a large majority of the cases. Somehow the very people that should understand this, the people of this forum, would prefer that we have everyone bury their heads in the sand and pretend that they can't be infected.
Somehow the consensus seems to be "Wait until they go to the hospital with life threatening OI's and no immune system."
I'm truly amazed that the people of this forum that are highly educated with respect to HIV/AIDS, it's transmission, progression, and treatment process would argue against early detection in a manner that is at no charge to the patient, non-mandatory, and fully consented.
The issue here is not "non-mandatory, and fully consented testing", nor do I see anyone arguing that we should "bury our heads in the sand and pretend we can't be infected".
The program at UAB is fully consented with the exception of unconscious patients.Oh my God, do you not, can you not see the issue with this, let alone if someone was conscious! You clearly are close to a state of un.........
The only flaw is implied consent of unresponsive patients. This is a very small subset but should be reconsidered.
Oh my God, do you not, can you not see the issue with this, let alone if someone was conscious! You clearly are close to a state of un.........So now you'll attack someone for disagreeing with you and presenting clear argument as to why there is disagreement.
The small subset of patients that present in an unresponsive state being the exception. I agree implied consent with these patients is perhaps something to be reconsidered.Now granted I might just be waking up from a self induced coma, but this is what you wrote, and honestly, "small" and "responsive" should perhaps be left to "Off Topics" or another site.
Now granted I might just be waking up from a self induced coma, but this is what you wrote, and honestly, "small" and "responsive" should perhaps be left to "Off Topics" or another site.
Beginning in mid-July, UAB (University of Alabama at Birmingham) Hospital will start screening all ER patients (unless they sign a form to opt-out) for HIV. If they come in unconscious or unable to communicate, they will be tested.
Overall, I think it's a good idea to do routine testing, but I know the funding is not there to treat those who test positive. Our patient load has already surpassed 2,000.
3) If testing is going to be done - then it is imperative to have a plan of action to link the person to treatment - keep in mind that treatment doesn't always mean going straight onto meds - it is just that - treatment (i.e. seeing a doctor, getting all of the baseline labs done, regular monitoring, whether the person is on meds or not)
4) It is also imperative to have other support structures (i.e. mental health counseling) accessible - as we can see just from these forums and the AM I forum, getting tested can bring up a lot of emotions and worries - this doesn't mean a person shouldn't get tested, but it does mean that a testing program has to have adequate resources to provide appropriate pre and post test counseling. This may be difficult to do in the fast moving and very transitional environment of an emergency room.
It's a virus and if we keep treating it differently from all other viruses, then the general public will also continue to treat it differently.excellent point! ;)
The one thing I don't get about this particular argument (I'm not picking on your Phil -- many of voiced it here and in past threads on this topic) is:
If these requirements can't get met and testing is not done (with consent or not), then we really don't alleviate the NEED for treatment and support -- we are simply avoiding the KNOWLEDGE of the NEED.
I've always been confused as to why we say, in one breath, that we need to fight stigma of HIV, and in the other say that we need to provide extra special hurdles to it.
We tell people that they should let the health care providers know about their status so that they can be properly treated, yet we put up barriers to those that don't know from finding out -- so they can't get proper treatment.
It's a virus and if we keep treating it differently from all other viruses, then the general public will also continue to treat it differently. There are damned few medical tests that require written consent -- I can't even think of another right now, although I'm sure there must be.
Anyway -- my point is that at some point in time, we all have to stop treating this virus in accordance with it's stigma -- else we will never lose that stigma.
Mike
I agree with routine testing and it should be treated just like any other condition. Yes it's true that many are not going to have access to treatment at the time they're tested, but at least they'll know they need to be looking for a way to get help and maybe get in line for assistance. It's terrible to find out you have HIV, but the earlier you know you have it, the better off you will be.
I think the point about the need for informed consent is a valid concern, but I think that in this instance, the right to choose comes at too high of a cost. I'd rather be alive and physically healthy with the pain of a stigma than stigma free and slowly dieing and infecting others.
The right to choose is not an absolute one. That's why we have to wear seat belts and pay for hospitals, fire and police with our tax dollars. I think testing is just one of those small categories of things where there is just not a good enough reason for any person to choose not to do it.
Also, I would think if you're bending over to backward to opt out of testing, then you are probably the person that needs to be tested the most.
Exactly. If we had the attitude that HIV is no different than TB, the stigma would go away, people would get tested, yada yada yada. Make anyone with HIV eligible for Medicare (hence those without insurance can get treatment) and we have an effective path to reducing or eliminating transmission. Doctors test, without consent, for all sorts of things. Hepatitis anyone? VDRL anyone? Syphillis anyone? Low testoserone anyone? They're tested without consent. But the stigma of HIV requires consent before testing. How dumb can we be. HIV will continue to spread until we test, test, test, at every opportunity, and offer treatment immediately. Give us Medicare if we are HIV+, which makes immediate treatment possible. Lets go for the 96% reduction in transmission and get rid of HIV!
My two cents.
I think we're in agreement re stigma. I'm just taking it a step farther, as otherwise I don't see an end to HIV. We're in this 30+ years, and progress, but still more and more infections, little drop in spread. Desperate times call for desperate measures?
I just figure if the government (in the name of national security) can now tap our phones without consent (including all cellphone records), monitor emails, chats, etc. without even a judge's approval, and touch our junk if they want at the airport, taking our blood isn't that far off. The republicans are already trying to force every woman who's pregnant to carry full-term, which means they control women's bodies. What's a mere needle compared to that!?
Honestly, I think you are reaching here. Increased testing is very good idea -- FORCED testing is not.
Taking our blood is indeed very, very different from the scenarios you are equating it with here. If you don't want to be screened by airport security, don't fly. If you don't want your email monitored, don't send any. If you don't want your phone tapped, don't use one. Now -- I'm not saying that I agree with the gov't doing those things, but you do have ways to avoid them. Everyone has blood, therefore no one could legally avoid mandatory testing.
Mike
Yes, I agree that OF COURSE I'm reaching. Most successful change in any field throughout history has come through radical change, radical thinking. Ejecting the status quo from the argument. "I think there is a world market for maybe five computers," probably erroneously attributed to Thomas Watson, head of IBM Yeah, right. Whoever said it was thinking status quo.
Yes, I'm reaching.
Bocker --
Think about it. There already ARE penalities if you infect someone and they go to the law. You can be put in jail. Just being HIV+ and spitting are now cause for prison. So having sex while HIV+ is illegal in many States. Even IF you disclose first, the partner can say you didn't. You lose. Is THAT constitutional?
I'd suggest that there IS a compelling State interest. Why is there a State interest to keep you from comitting suicide? It's illegal, right? So having a deadly virus (and passing it around) would seem to have the same State interest. I don't see in the Constitution where it prevents mandatory blood testing. I've read it several times now, and based on other searches/seizure precedents (airports, anyone?), there is no right like that. It might be damned unprincipled to do it, but not unconstitutional as I read it.
However, I have to respond to this, because you have, once more, taken a line out of a much larger post to try and pick a fight.Now let me address this. That was not my intent and if that was the way it was perceived by others, I apologize. However this post by you, when you had not involved yourself before, is much like calling the kettle black.
Now let me address this. That was not my intent and if that was the way it was perceived by others, I apologize. However this post by you, when you had not involved yourself before, is much like calling the kettle black.