HIV/AIDS Testing

The Centers for Disease Control (CDC) is responsible for all disease testing guidelines including HIV testing.  The newly proposed CDC HIV testing recommendations are based on years of research and documented consistency in the growth of the disease.  According to an article published in the September-October 2007 issue of “Public Health Reports”, many people do not even know that they are infected.  One-quarter of those who are currently infected in the nation are totally unaware of their status.  This is a tremendous number especially since 40,000 new people are diagnosed each year.  This means that there are still another 13,333 United States Citizens that are currently HIV positive and do not know it because of lax guidelines for testing the population.

Reasoning behind these new recommendations is twofold.  The first and most important reason is because it would incorporate testing individuals that would not have previously fit into the standard group of persons being tested.  Currently, many people are overlooked in HIV testing due to cost of testing and quality of healthcare available as well as undocumented risk factors.

Most HIV testing is done based on stereotypical risk factors such as drug use and alternative lifestyles.  This type of testing is mostly inaccurate due to the truthfulness of answers received.  People who are ashamed or embarrassed of activities they are involved in often lie about those activities, which may result in them not being tested when they should be.

The second reason behind the new recommendations is to incorporate the testing into more of a routine procedure so that many more people will be tested.  Many people who are not normally a candidate for HIV testing will also be tested by following the updated recommendations.  This simple measure is designed to slow down the spread of the disease as much as possible.  People who would have not known that they had the disease can find out as the result of a routine checkup.

Original recommendations of HIV/AIDS testing as pertain to the Ryan White Care Act were very vague with no true guidelines.  However, funding under the Ryan White Care Act only provided for treatment of patients with full blown AIDS.  These old recommendations were designed to protect patient privacy, which resulted in only certain “high-risk” patients being tested for HIV.

The original guidelines required that patients only be tested if they showed obvious risk factors that are common in documented HIV/AIDS cases.  If the patient was determined to be a high-risk, he or she was given the option to be tested and there was generally a large fee and long wait time associated with the test.  For these reasons, thousands of infected people around the country have never been tested.  Over the years, it has become more difficult to determine who is a high-risk patient.  Everyone in the country should be considered a potential carrier and tested periodically, but the old recommendations did not take this into consideration.

Recommendations were not based any actual legislation until the Ryan White Care Act of 1990.  Before this, testing of HIV/AIDS was performed only in cases where doctors were already sure that the patients had contracted the disease.  The testing was also performed in patients who were categorized as extremely high risk.  During this time period, testing and treatment were extremely expensive.  Test results were not received for up to two weeks and treatments were not very successful.

By the mid 1990s, testing and treatment of the disease had evolved dramatically.  An article published in the New England Journal of Medicine in 1995 that was written by Peckham and Gibb showed that testing and treatment of pregnant women could actually reduce the chances of disease transmission from mother to child.  Due to these tremendous findings, Congress enacted legislation to encourage routine prenatal screenings.  While this routine screening was highly discussed, there were no clear cut guidelines for testing.  The routine testing that was recommended during this time would have been a perfect start towards wiping out HIV and AIDS in the United States if local healthcare providers had been forced to follow these suggested procedures.

Shortly after this time period, the Institute of Medicine (IOM) panel recommended that all pregnant women be tested for HIV/AIDS.  This led to a change in the CDC’s prenatal testing guidelines in 2001.  The IOM suggested “opt-out” voluntary testing, but the CDC required actual informed written consent.  Many state and local laws would not allow for prenatal testing based on the suggestions of the IOM.  These same laws also acted as a barrier to testing people in groups other than expectant mothers.

State and local laws in the mid 1990s were very often barriers to implementing a consistent guide to HIV testing.  Most local laws required extensive training and certification in order to perform the tests legally.  These extreme requirements severely limited the number of authorized testers, which also limited the number of people who could be tested.  Many state laws also required that pretest counseling be performed to include an informed consent from the patient.  All of these factors have slowed down the testing process in the past, but many states are currently changing laws to make the testing process much more streamlined.  These older recommendations and local laws preventing routine testing have resulted in the current condition of the HIV/AIDS epidemic.

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