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Routine HIV Testing????
Dec 2, 2007

Hey Dr. Bob,

I've been reading the archives as you so frequently suggest and they are not only extremely informative but freaking hilarious as well. I have a question. (You probably saw that coming now didn't you?) I was just wondering why you seem to be not such an ardent fan of the new recommendation to HIV test everyone. Why not?

Zeb

Response from Dr. Frascino

Hi Zeb,

I'm actually not against routine HIV testing as a principle but rather I have some concerns about the currently proposed plan in light of limited HIV/AIDS prevention dollars. It's more of a where can you get the best bang for your buck, so to speak, when your bucks are limited. Please note Dubya, in his infinite (or should that be infantile?) wisdom has cut domestic HIV spending by 19% from 2002 to 2007 (using inflation adjusted dollars). So, yes, it's true I do worry about the rationale for "routine HIV testing" as currently proposed. The main reason is that while Dubya and his neocon dimwitted buddies seem to have unlimited funds to waste on the disastrous war in Iraq and useless missile defense shields, they have only limited dollars for HIV prevention. Back in 1996, twenty-five percent of the CDC's HIV/AIDS prevention budget was allocated for HIV testing in predominately low-risk populations. It was their single biggest HIV-prevention expenditure. Eric Goosby, MD was the director of the HIV/AIDS Policy Office at that time. He now states this expenditure "was not efficient nor effective in picking up HIV-positive people." So now the CDC is promulgating an even more wide-ranging program opt-out testing, which does not require risk assessment or counseling, for all health care encounters in persons aged 13 to 64 years!

First off, one wonders about the 64-year cutoff. (Are Bush/Cheney planning to outlaw sex after 64?) But never mind that. Recent studies at the Johns Hopkins School of Public Health have found that the rationale for the current "routine testing" plan are just as misguided as the CDC's less ambitious program of 1996! Cost-effectiveness analyses indicate that when we have limited resources to spend on prevention, targeted services would help diagnose three times as many infections and prevent four times as many infections. So for now, I would say the jury is still out on the wisdom of implementing this new policy in light of the 19% decrease in spending for domestic HIV/AIDS prevention from 2002 to 2007 (using inflation adjusted numbers). It's probably not as big of a bungle as, say, Bush's handling of Hurricane Katrina, the environment or Iraq, but let's just say it fits right in there with his policy of consistency and efficacy. That's consistently getting things wrong and effectively making things worse.

Dr. Bob



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