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WEPA! (CDC's REVISED RECOMMENDATIONS FOR HIV TESTING)
Apr 6, 2007

That's the spanish WOO-HOO! I just got my results and passed. That Home access test takes 3 days not the advertised 1 :O/

Thanks for this site. What your doing is wonderful and encourages many like myself to do what we must and just get tested.

My question is, When you go to a doctor for a regular physical, and they take blood for cholesterol, anemia, and all the other general check-up stuff. Why don't they check for HIV also?? It doesnt make sense to me. I live in an area of High HIV Rate and there a posters everywhere on testing. But when you go to a doc you have to ask for it.. WHY? Wouldn't this slow the spread and help with early detection????

I'm sending you a donation, wish I can afford to send much more. Many thanks for your insight, support, and hope. Thanks, Tony.

Response from Dr. Frascino

Hola Antonio!

Congratulations! WEPA!!!!

Why is HIV testing different from cholesterol and anemia testing? Well, for one thing, you aren't at risk of being discriminated against if you happen to be anemic or have high cholesterol. There are very good arguments both for and against "routine" HIV testing. However, HIV is indeed quite different from other illnesses. Perhaps it shouldn't be, but that just isn't the reality of the current situation. Testing positive can in some countries lead to deportation. In this country, it has led to losing one's job, domestic violence, divorce, alienation from friends and family, etc. Had we done more over the years to decrease HIV stigmatization and discrimination, perhaps routine HIV testing would have become more routine years ago. The CDC has recently proposed increased testing and the debate continues to rage on. See below.

Dr. Bob

Fact Sheet: CDC's Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health Care Settings

September 21, 2006

An estimated one-fourth of the roughly one million Americans believed to be living with HIV remain unaware of their infection. New approaches are urgently needed to reach these individuals with information on their HIV infection, and are essential to the success of HIV prevention and care efforts in the United States. Early diagnosis is critical in order for people with HIV to receive life-extending therapy. Today, nearly 40 percent of individuals diagnosed with HIV are diagnosed within one year of developing AIDS, when it may be too late for them to fully benefit from treatment. Additionally, studies show that most people who learn they are infected take steps to protect their partners, while people who are unaware of their infection are estimated to account for between 50 and 70 percent of new sexually transmitted HIV infections. In order to increase the proportion of HIV-infected Americans who know they are infected early in the course of infection, the U.S. Centers for Disease Control and Prevention (CDC) has published revised recommendations for HIV testing in health care settings. The recommendations are designed to make HIV screening a routine part of medical care for all patients between the ages of 13 and 64, and to improve diagnosis of HIV infection among pregnant women.

The revised recommendations address HIV testing in health care settings only. They replace CDC's 1993 Recommendations for HIV Testing Services for Inpatients and Outpatients in Acute-Care Hospital Settings. They also update portions of CDC's 2001 Revised Guidelines for HIV Counseling, Testing and Referral and Revised Recommendations for HIV Screening of Pregnant Women. The new recommendations do not alter current recommendations on HIV counseling and testing in non-clinical settings, such as community centers or outreach programs.

Removing Barriers to HIV Screening in Health Care Settings Health care settings represent a major opportunity for early diagnosis of HIV infection. Yet HIV screening rates remain low in many of these facilities. In one study of people who had reasonable access to medical care, more than 60 percent of those newly diagnosed with HIV had already progressed to an advanced stage of disease, suggesting that many had missed key opportunities for diagnosis at prior medical visits. CDC's previous HIV testing recommendations for health care settings called for routine testing for people at high risk, and for everyone (regardless of risk) in settings with HIV prevalence above 1 percent. However, several key barriers hindered the implementation of those recommendations in health care settings. Many providers report that they do not have information about HIV prevalence in their facilities, or do not have sufficient time to conduct risk assessments. Physicians also report that the processes related to separate, written consent and pre-test counseling have posed significant barriers. For example, one recent study found that even for patients presenting with other sexually transmitted diseases (STDs), HIV testing is rarely provided. In that study, 76 percent of emergency department professionals said they never or rarely encouraged HIV testing for these patients, primarily because the HIV testing process is too time-consuming or because they are not certified to provide counseling. CDC's revised recommendations are designed to help remove these barriers by simplifying the testing process and making HIV testing a routine part of care for all patients aged 13-64.

Key Recommendations for Adults and Adolescents

Provide HIV screening for all individuals ages 13 to 64 in health care settings: To normalize HIV screening as a routine part of medical care, the revised recommendations advise that all patients aged 13-64 be screened. Screening that is universal, and not tied to risk behaviors, will help maximize opportunities for early diagnosis in medical settings and reduce the stigma still associated with HIV testing. The recommendations do not specify the frequency of screening for all patients, but do encourage repeat testing at least annually (or more frequently if risk behavior dictates) for patients with recognized risk factors. This includes individuals with HIV-positive sex partners, injection drug users and their sex partners, individuals who exchange sex for money or drugs, and individuals who have had, or whose sex partners have had, more than one sex partner since their most recent HIV test. In addition, all patients initiating treatment for tuberculosis or seeking treatment for STDs should be screened.

Voluntary, "opt-out" approach: CDC's recommendations strongly emphasize that HIV testing must be voluntary and undertaken only with the patient's knowledge. The recommendations advise that patients be specifically informed that HIV testing is part of routine care and have the opportunity to decline testing. Before making this decision, patients should be provided basic information about HIV and the meaning of positive and negative test results, and should have the opportunity to ask questions.

Simplified testing procedures: To overcome the most significant barriers to testing in health care settings, the recommendations advise that pre-test counseling and separate, written consent for HIV testing should no longer be required. Consent for HIV testing can be incorporated into general consent for medical care. In terms of counseling, the recommendations underscore the need to ensure that patients who test positive for HIV are provided prevention counseling and linked to ongoing care. CDC also continues to encourage prevention counseling for all patients where feasible, especially when the health care visit is related to substance abuse, sexual health, family planning, or comprehensive health assessments. In addition, intensive HIV prevention counseling for high-risk populations will remain a vital component of community-based HIV prevention interventions.

Key Recommendations for Pregnant Women Existing recommendations for routine prenatal HIV screening have already contributed to remarkable success in preventing mother-to-child HIV transmission in the U.S. The estimated number of infants born with HIV declined from a peak of approximately 1,650 in 1991 to fewer than 240 each year today. The revised recommendations include measures to further that progress.

Rapid testing during labor for women of unknown status: A large proportion of perinatal HIV transmission occurs among women who lack prenatal care or who are not tested for HIV during pregnancy. Existing CDC recommendations advise that HIV testing should be provided during labor for women whose HIV infection status remains unknown. To more quickly diagnose HIV and initiate antiretroviral prophylaxis to women who test positive, the revised recommendations advise that a rapid HIV test should be used for testing during labor. If the rapid test is positive, prophylaxis can be administered before results of a confirmatory test. If HIV status cannot be determined prior to delivery, the recommendations advise that women should be voluntarily screened with a rapid HIV test immediately post-partum. Rapid HIV testing is recommended for newborns when the mother's status remains unknown.

Expanded repeat HIV screening in the third trimester: Available data suggest that an increasing portion of mother-to-child transmission may result from HIV infection that occurs among pregnant women after they test HIV-negative earlier in their pregnancy. CDC's existing recommendations advise that women with known risk factors receive a second HIV test during the third trimester. To further increase diagnosis, the revised recommendations also advise repeat testing in the third trimester for all women in areas with high HIV prevalence among women of childbearing age (15 to 45) or in facilities with at least one HIV diagnosis per 1,000 pregnant women screened. Providers should consider repeat testing in the third trimester for other women on a case-by-case basis.

Process for Developing and Finalizing the Recommendations The revised recommendations represent the culmination of an extensive process that began in 2003, as part of broader efforts to increase early HIV diagnosis. One of the key strategies was to make voluntary HIV testing a routine part of medical care. For the past three years, CDC has been working with national, state, and local partners to identify the most effective ways to achieve this goal. CDC issued interim guidance in 2003 to guide state and local efforts to develop programs for routine testing, and implemented multiple demonstration projects to evaluate potential approaches for overcoming barriers to testing.

In 2004 and 2005, the agency convened two consultations with health care providers, public health experts, insurers, community-based organizations, and advocates to solicit further input. Based on the lessons learned from these efforts, CDC developed draft national recommendations and distributed them in early 2006 to diverse professional, scientific, and community-based organizations around the country for review and comment. The draft recommendations were also submitted for scientific peer review.

In response to comments on the draft recommendations, CDC strengthened guidance on several key issues. The final recommendations include stronger language on informed consent to ensure that no one is tested without his or her knowledge. They emphasize the need to provide basic information about HIV and the meaning of positive and negative test results, with the opportunity for patients to ask questions, prior to consent. The final recommendations also indicate that informational materials should be made available in multiple languages whenever appropriate, and that interpreter assistance should be provided for those with limited English proficiency. Finally, CDC stressed strong continued support for prevention counseling in health care settings, where feasible, and in community-based HIV prevention programs for high-risk populations.

Next Steps for Implementing the Recommendations CDC's revised recommendations are one of the many steps that CDC, in conjunction with multiple private and public sector partners, is taking to ensure that individuals in health care settings have the opportunity to learn whether they are infected with HIV. To support health care providers, CDC will issue additional guidance in early 2007, which will provide examples of model approaches and practical tools for implementing the recommendations in various types of health care settings. CDC will also continue working with public and private insurers to encourage coverage for routine HIV screening, which studies have shown to be as cost-effective as other routine health screening programs, such as Pap smears and mammograms. It is important to recognize that while knowledge of HIV infection status is critical, testing efforts must be part of a comprehensive program of prevention and care. CDC is working with the Health Resources and Services Administration and the National Association of Community Health Centers to ensure that newly diagnosed individuals have access to necessary treatment and ongoing prevention services. CDC is also conducting demonstration projects in several states to improve linkages from emergency departments to primary care for people newly diagnosed with HIV.

In addition to efforts to expand HIV testing in health care and community settings, CDC continues to support the full range of HIV prevention interventions needed to reduce HIV infections in the U.S., including comprehensive interventions for both high-risk and HIV-infected individuals.

American Academy of HIV Medicine Endorses New HIV Testing Guidelines; Remains Concerned About Funding for Tests and Treatment Academy to Educate Providers About Implementation

September 21, 2006

Washington, DC -- The American Academy of HIV Medicine has endorsed the revised recommendations for HIV testing in health care settings from the Centers for Disease Control and Prevention (CDC), which recommend significant expansion of routine HIV testing throughout the health care system.

The Academy remains about successful linkages to medical care and prevention services for new positives, as well as around patient privacy, informed consent, and funding to support care for the newly diagnosed. Further, this initiative will generate significant challenges to already under-resourced medical and associated social service systems (including emergency departments, inpatient wards, outpatient clinics, laboratories and social work services).

Despite these concerns, the Academy recognizes the overwhelming necessity of identifying unrecognized HIV infections as a benefit to the public's health and its access to life-saving therapies. "It is crucial that we expand the 'who' and 'how' and 'where' of HIV testing, and we support the CDC's lead on finally putting that in motion," says Dr. Jeff Schouten, AAHIVM Board Chair. "We support the CDC's lead to revolutionize HIV testing in our country's health care settings. We hope to rectify our concerns over insufficiencies and inconsistencies with the CDC guidance; nevertheless, we will work to educate all medical providers on how best to implement these recommendations for their clinics and for their patients."

AAHIVM hopes to reconcile over time the unintended consequences of the implementation of these guidelines including the likely decrease in risk assessment and subsequent risk reduction counseling, the vagaries of how "opt-out" provisions would be defined, and the challenge of linkages from positive test results directly into a good medical care system for patients.

"We feel the CDC's revisions unduly minimize risk assessment and risk reduction counseling for patients of varying risk. Counseling just naturally goes with testing, as diet does to exercise," says Jeff Schouten, Board Chair for AAHIVM. "Though it may not always be feasible to do in-depth risk assessment and appropriate risk reduction counseling with every patient, we also don't want to discourage it either. There needs to be a greater emphasis on identifying community-based prevention resources and facilitating these linkages so the patient who tests HIV negative does not leave the encounter thinking they are not at risk, if indeed they may be." The Academy also strongly supports an "opt-out" approach to testing, meaning that the test is universally offered but that patients can then decline -- but only assuming that all patients tested are told about the test and what the results do and do not mean, and that they be explicitly told they can refuse the test if they want.

"Informed consent does not have to be written nor does it need a patient's signature," says Michelle Roland, Vice-Chair for AAHIVM, "but it does need to be 'real'. We fear that the CDC's recommendations will lead to clinicians simply telling the patient he or she will receive a test. We need to be very clear that there is a likelihood that will happen in many clinical settings; quality assurance activities and continuing provider education on this issue will be critical, but it will also require additional resources and expertise."

Throughout all health systems, AAHIVM insists that direct, dependable linkages to care are absolutely critical to any screening and testing program, especially with public health networks for HIV patients already over-capacity.

"We can't assume that once we discover someone's HIV infection that we'll be able to help and direct them into reliable care," said Dr. Schouten. "It would be irresponsible to take such a significant step with patients and then send them off on their own. HIV care is too complex and too important, and we need to ensure that those doing the testing are confident in deciding the next steps after positive test results." Finally, of course, there is the issue of money. AAHIVM has strong concerns that there are not enough resources, public or private, to fund expanded testing. "Testing more people obviously takes money, and CDC doesn't have it. Who's going to pay for it?" asks Schouten.

Federal HIV Testing Initiatives Can Only Succeed with Expanded Healthcare, Patient and Provider Education September 21, 2006 The undersigned regional and national organizations released today this statement in response to new guidelines by the U.S. Centers for Disease Control and Prevention (CDC) on HIV testing in healthcare settings: We support the routine offer of HIV testing Expanding the offer of voluntary HIV counseling and testing services in healthcare settings is good public health policy. Routinely offered HIV testing will help reach more individuals who may be unaware of their HIV-positive status as well as those who are HIV-negative but engaging in high-risk behaviors. Encouraging individuals to learn their status will help slow the spread of HIV and assist those who are HIV-positive live healthier, longer lives. We support CDC's recommendation that HIV testing remain voluntary and free of coercion Mandated or coercive testing strategies threaten to alienate people with or at risk for HIVthe very individuals whose involvement is pivotal to successful efforts against the epidemic. By merely encouraging testing, and ensuring it is readily available and properly explained, most people will recognize its benefits and accept testing on their own volition. The new CDC guidelines' recommendation of reliance on a patient's general consent to medical services without a requirement to document the offering of the test and the right of the patient to refuse without penalty does not, especially in the context of hectic and understaffed clinics and emergency rooms, constitute voluntary, consensual testing. Non-consensual testing violates individuals' basic human rights to consent to their own medical procedures. We strongly disagree with CDC recommendations to eliminate pre-test counseling and informed, written consent to testing An expanded focus on testing without counseling and written, informed consent will put people at risk for testing without their prior knowledge or approvala clear violation of medical ethics and human rights. De-linking counseling from testing is also highly problematic for many vulnerable populations. For example adolescents and young people, who are at particularly high risk of stigma and rejection from family and friends when disclosing their HIV status and who are often dependent on adults to access health care services and reimbursement, may not be fully prepared for the consequences of an HIV diagnosis in the absence of counseling and written, informed consent. Pre-test counseling and informed, written consent to testing open conversations about HIV/AIDS between patients and providers and help dispel commonly held myths that perpetuate high-risk behaviors and stigmatizing attitudes. Open and honest communication about HIV/AIDS and the behaviors that can (and cannot) transmit HIV are instrumental to progress against the epidemic. Accurate education about HIV/AIDS must be expanded on a scale equal to or greater than the expansion of HIV testing. We support efforts to develop new, innovative strategies to expedite counseling and informed written consent to HIV testing We urge CDC to develop, pilot, and disseminate new models that offer clients much briefer means to receive context-appropriate HIV counseling in various settings. We also support the development of innovative ways to speed the attainment of written informed consent to testing. Testing conducted without these important components, however, will forgo critically important opportunities to educate at-risk individuals about HIV prevention. Several of the undersigned organizations have examples of such initiatives in use across the country and urge CDC to use the opportunity to learn about and implement our best practices. We call on CDC to address the needs of HIV-negative individuals at high risk of infection and people without regular access to healthcare We are gravely concerned that high-risk HIV-negative individuals will fail to receive the education and support they need to remain HIV free under testing procedures that exclude counseling and informed written consent. Without any counseling or attempts to link people into risk-reduction services, these high-risk negatives may be misled into falsely believing that a negative test result means that they are not at risk for HIV, thereby increasing their risk. The fact that not all populations with high rates of undetected HIV will encounter a clinical setting where they may be offered an HIV test must also be taken into consideration in attempts to reduce racial disparities in early diagnosis of HIV, and strategies to reach them must be adequately promoted and funded. We strongly object to the limited degree of input solicited from community stakeholders in the development of these guidelines and the secrecy with which CDC advanced and finalized them In March 2006, CDC developed and quietly circulated a draft of its revised HIV testing guidelines, sidestepping the typical public posting process in the Federal Register that generally allows 60 or more days for public comment. Instead, CDC sent its draft revised guidelines to a select group of individuals and allowed just 15 working days for the selected interested parties to register their opinions. While CDC did solicit input from clinicians and other medical providers, we believe efforts to involve people living with HIV, community advocates, social workers, outreach workers, local administrators of HIV services, and other workers responsible for conducting HIV testing were wholly insufficient. CDC has demonstrated a pattern of secrecy and poor engagement of stakeholders in regards to HIV prevention policy. Reviving our nation's lagging HIV prevention efforts will require new, collaborative relationships that engage and involve AIDS community members. We call on CDC to involve greater numbers of people living with HIV, community stakeholders, and clinicians in efforts to strengthen HIV testing promotion and acceptance in the U.S. We agree that testing modalities can and should be improved to account for changes in technology, the growth and diversity of the epidemic, and the need to reach more people with HIV testing, prevention, and care services. We also believe CDC should take a leadership role in developing and widely disseminating proven models to deliver voluntary HIV counseling and testing services in ways that expedite counseling and the attainment of informed, written consent to testing. Federal initiatives to expand the offer of HIV testing, however, must be guided and informed by the experiences of people living with HIV/AIDS, community-based organizations, and HIV clinicians who are at the forefront of the fight against the epidemic. We believe that the effects and impact of routine offering of HIV tests in healthcare settings must be carefully documented and analyzed The effectiveness, costs, barriers, correlates of relative success and possible unintended consequences of these guidelines must be documented and characterized in whatever form these recommendations are promoted and implemented. Key questions must be answered such as how many new cases of infection are diagnosed in this way compared to other strategies, what proportion of people with newly recognized HIV are successfully linked to ongoing care and which populations are most receptive to routinely offered screening tests. The CDC must call for adequately funded operation research to track and report on the outcome and impact of these recommended practices both in themselves and as compared to alternate uses of the same resources. We believe testing promotion alone will not reverse the escalation of HIV/AIDS in the U.S. In the absence of fully accessible HIV care, treatment, and support services, and a more robust HIV prevention agenda, federal efforts to expand HIV testing promotion will ultimately fail at decreasing HIV-related morbidity, mortality, and new infections. The federal government must match its support for HIV testing with proven prevention and care strategies to adequately address the size and complexity of HIV/AIDS in the U.S. today. All testing, prevention, and care measures also must include targeted approaches to meet the needs of those at greatest risk of infection and transmission, as well as those at risk of not seeking care once diagnosed. We believe funding for new testing initiatives should be in addition to existing program funding Expanding support for the routine offer of HIV testing should not shift funds away from more targeted, community-based testing or HIV prevention programs. Indeed, Congress must appropriate a minimum $1 billion annually for HIV prevention programs in order to begin to reduce the number of new HIV infections that occur annually in the U.S. In addition, the CDC should make clear that it expects the costs of offering routine HIV testing and counseling in healthcare settings to be borne by insurers and other payers already covering the costs of the care being sought. Endorsing organizations: ACT UP Philadelphia African American Health Alliance (AAHA) AIDS Action in Mississippi AIDS Alliance for Children, Youth and Families AIDS Foundation of Chicago AIDS Legal Council of Chicago AIDS Network, Madison, WI AIDS Survival Project American Medical Student Association (AMSA) amFAR, The Foundation for AIDS Research Brothers Uplifting Brothers, Inc., Merrillville, IN Community HIV/AIDS Mobilization Project (CHAMP) East Bay AIDS Advocacy Foundation Ebony Sisters Campaigning for AIDS Prevention Education (ESCAPE) Gay Men's Health Crisis (GMHC) Harm Reduction Coalition Heartland Health Outreach HIV Law Project Housing Works Lambda Legal Minnesota AIDS Project National Minority AIDS Council (NMAC) New York State Black Gay Network Ohio AIDS Coalition Pediatric AIDS Chicago Prevention Initiative Project Inform Sexuality Information and Education Council of the United States (SIECUS) The AIDS Institute (TAI) The Well Project The Woodhull Freedom Foundation



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