Haven’t seen a GD about the merits of ‘routine’ STD testing, a MPSIMS notification thread or even a Pit rant regarding the following story that CBS is quoting from MebMD:
The headlines tend to overblow these still unfinalized & minor changes in guidelines - so I have a hunch most won’t consider it a big deal.
Today’s WSJ went a step further and reported the CDC will “no longer require patients to sign informed-consent forms before submitting to an HIV test.”
Seeing code words like: “mandatory,” “surveillance” and “radical changes…no longer requiring pretest counseling” added to the fact the Boston Globe reported in late April that
Maybe one of our local legal-eagle types can fill us in on precedent for doctors reporting cases of contagious diseases. I seem to recall something similar for doctors reporting suspected SARS cases, but that’s not quite the same thing. I dunno; I see what the CDC is trying to do and it’s a noble effort, but I don’t like the idea of mandatory testing for something that certainly does carry a social stigma, and especially don’t like the idea of there being a big ol’ government list of HIV+ people. Are doctors required to report cases of other diseases?
It varies from state to state which are required to be reported, but all states have a list of diseases which must be reported. These usually incluse sexually transmitted diseases–syphilis, gonorrhea, etc.–so I can see it being consistent to require reporting of HIV. The government is supposed to keep this information, but I don’t like the idea of a big government list o’ HIV patients either.
I’m still not sure how it would work with not requiring informed consent for an HIV test–I’m not aware of any precedent for that. I’ve always learned that it is negligent to do anything without informed consent.
I haven’t formed an opinion of the topic as a whole yet; but this doesn’t make sense to me. If everyone is getting the test doesn’t that remove the social stigma.
I’m definately against a LIST. I can understand doctors reporting data such as age and gender; but not personal identity information.
I’m not sure how I feel about mandatory testing - how mandatory are we talking about? But I would definitely love to see routine HIV testing for everyone at every yearly physical. And I would err on the side of “more routine” than “less routine.”
Way too many people at risk simply do not get HIV and other STI tests, because “that makes you into a slut” (as opposed to, you know, sleeping with a lot of people). It’s truly bizarre how taboo the notion of STI tests is, and maybe if physicians routinely offer them as part of the standard workup of a physical, that stigma would disappear.
Of course, I have little hope of any such measure being implemented (“They shouldn’t even be having sex! Abstinence only! Abstinence only!” as though chastity will prevent HIV transmission from a long-term partner/a blood transfusion), but it would be excellent. There is no good reason whatsoever for the current perception of HIV and STI testing, and it should become as routine as getting your knee hit with the little rubber mallet.
The stigma of the test, perhaps, but not the stigma of the disease itself.
I think it’s a good idea, as matt says, to make the testing more “routine.” Many people (myself included, at this particular stage of my life–not saying anything about previous stages, though) would not go to the trouble of going to get an HIV test simply because they think they’re not terribly at risk at this time. Personally, I haven’t engaged in “risky behavior” in long enough that I don’t feel it necessary, but if my doctor were to recommend the test as part of a regular physical, I would certainly take her up on it.
It seems like a waste of money, doesn’t it? I mean, I’m not at risk for AIDS…I don’t have sex, don’t inject myself with anything, and neve have had a blood transfusion. So how does it make sense for the doctor to give me an AIDS test? I mean, he doesn’t test me for malaria either, because, again, it’s not a risk. Do you just start testing everybody for everything?
Captain Amazing, have you ever looked at the numbers of pregnancies that happen at colleges? Most of the women involved, when the doctor suggests testing for that, begin by using just that sort of argument: Why test for something that I couldn’t possibly have?
The sad fact is that, when related to sexual activity, patients lie to doctors. Regularly. Not saying that every patient will. But given, say 100 patients, at least 25 will.
I never knew there was a stigma to having the testing done. I’ve got to get my stigma helper’s kit.
I am for routine testing but against a list with identifying info. I think it is getting more common though, I have never gone in to specifically be tested but I know I have been tested 4-5 times. Blood work before marriage, again when I was pregnant, before donating blood / plasma, etc. I am not offended when Dr.'s say they are taking a blood sample to test me for anything, I figure they are doing their job.
I have been treated / tested for other things before only because I know they do it to everyone to make up for the people who lie. I don’t know if it was completely mandatory or just the Dr’s own policy though. One example is when I was pregnant I was treated for conflicting RH factor but they didn’t even bother testing my husband to see if I needed to be treated. I was told this is to protect women who may be afraid to admit if the baby may not be their partner’s and so they would forgo treatment instead. I didn’t enjoy getting the shots and I would have preferred to know if I could avoid them, but I didn’t raise a stink about it. (As it turns out, baby was born with positive RH so I did need them after all.)
I wonder what they would do if someone just refused to consent though - hold you down and force a needle in you? I guess they could make testing mandatory before getting a state ID or driver’s license or something but I have a hard time seeing how they could force every single person to get tested.
I’m not at risk. (I’m not in denial, I’m really not at risk). I admit that asking those who are at risk to self identify for testing causes a certain percentage of the population to be in denial about risk. I think that some of those who are in denial should be tested. I’m not convinced that testing everybody is a good use of resources.
Unless I’m much mistaken, the testing for the presence of HIV antibodies is a relatively simple drop-test. If the doctor has to take any blood for any other lab work, piggybacking this test onto it is minimal use of resources for materials or time at the lab.
If I’m wrong, I do hope someone with better knowledge than mine will come in to correct me.
You can object to the testing all you like, just saying that the resource use seems less than you seem to expect.
FWIW, the “pre-test counciling” mentioned really isn’t anything. I’ve never got more than “Okay, now we are going to do the AIDS test”- exactly the same fanfare I get for my PAP smear and reflex test and everything else that happens when I go to the doctor’s. Why should it be any different?
I’m not at risk, but I’d like to see some form of mandatory testing. The results should only be available to the patient and doctor. I think the only way to get some people that might be in denial about their risk tested, is some form of mandatory testing. If everyone that had HIV knew it, we’d have a better chance at stopping the spread of it.
I like the idea of routine testing. More testing is better than less, especially for something that is this serious, contagious, and silent.
The list… if it is 100% consistent with existing policy regarding other diseases, including other STDs, then I’m OK. If this is something special just for AIDS, let’s not, thanks.
Truthfully, I hadn’t given the actual amount of resources involved a great deal of thought. I don’t like the idea of testing everyone for AIDS, but it is an emotional, gut reaction “no”-- not a well thought out, defensible position. While a test with lower resource requirements per capita is less wasteful than one with high resource requirement, my initial post was not based on any kind of practical, cost-benefit analysis.
And now that I think about it, I’m not sure that you are wrong in your assumptions about how many resources are involved for an individual test. I still don’t like it. It is not a position reached by logic or that logic can reason me out of.
It removes the stigma of the test. It does very little for the stigma associated with the disease itself. Not saying the stigma is right or moral, but it’s certainly there. If you found out that a person you were romantically interested in was HIV+, wouldn’t that scare you off?
I agree with you that I’d have no problem with doctors reporting some basic demographic information about the patient, but I can’t think of a single use of the personal identity information being collected that wouldn’t amount to discrimination, or at least providing others the means to discriminate.