I'll Take the Paradigm Shift. Can You Super Size It Please?
By Ed Perlmutter
September 8, 2011
If for no other reason (and there are many other salient ones), the encounter described here explains precisely why routine opt-out HIV testing is the only testing method that should be instituted in Massachusetts. No one should settle for anything less; I certainly will not.
He said that during his recent annual physical he asked his internal medicine physician, who also happens to be gay, for an HIV test. Rather than offering him the associated pre-counseling, written informed consent paperwork and finally the HIV test itself, the physician instead balked.
"You don't need an HIV test," the (gay) physician said to the (gay) patient. "You're in a monogamous relationship."
"I never said that," the (gay) patient said to the (gay) physician. "I said I had a boyfriend."
And that's all she wrote.
As for me, I'll take the Paradigm Shift. Can you Super Size it please?
The internal medicine physician assumes his patient is in a monogamous relationship, and by doing so he does not have the courage to ask questions -- important questions -- about his patient's sexual partners and practices. And whether or not this man, who asked for an HIV test, is in a monogamous relationship with his boyfriend is not the point.
HIV testing should be free of assumptions and free of judgment. Or as Dr. Jonathan Mermin, director of HIV/AIDS prevention at the U.S. Centers for Disease Control and Prevention (CDC), recently stated, "It is the job of the health care system to make HIV testing as routine as cholesterol screening."
I could not agree more wholeheartedly. To better understand what Dr. Mermin means, all you have to do is read my story.
Physicians, who in the twenty-first century live and die by a time clock and the next lurking appointment, simply don't have the time or the inclination to engage patients in discussions about HIV. And so instead, like the assuming internal medicine doctor, the overwhelming majority of clinicians assume that they too know who their patients are and what they should or should not want regarding their own health care.
To patient: To help maintain your health, we're going to run complete blood work today, and an HIV screen will be part of that.
Patient: What if I don't want to be tested for HIV?
To patient: You may decline (or opt-out) of the HIV screening test and it will not be performed. Otherwise, you will be tested.
Routine opt-out HIV testing. Simple and straightforward, as it should be.
The final months of the 2009-2010 Massachusetts legislative session (which ended July 31, 2010) were literally pissed away on casino gambling legislation, which, might I add, did not pass that session nor did the routine opt-out HIV testing bill for which I so vigorously lobbied. In a "déjà vu all over again" moment, a new form of casino legislation was unveiled last week at our State House.
Former Massachusetts attorney general Scott Harshbarger and a leading gambling opponent said in a statement regarding the proposed bill that "release of new casino legislation signals yet another milestone in Beacon Hill's concerning slide deeper into a closed-door culture marked by little debate, less dissent and an even greater likelihood of improper influence." "Casino legislation" is disturbingly interchangeable with "HIV testing regulations" in Mr. Harshbarger's quote; and sad but true, this does not surprise me at all.
Why Massachusetts Department of Public Health officials and cohorts from HIV/AIDS and legal services organizations, those who worked behind closed doors with the legislators on the final version of the HIV testing bill, could not consult the very clinicians who are at the frontline of offering and managing HIV testing protocol leaves me (virtually) speechless and incredulous. Why could they not leave well enough alone? It is with a heavy heart that I too no longer support this bill in its present form, and neither should any reasoned citizen of the Commonwealth of Massachusetts.
Ms. Haag goes on to bemoan the cuts based on her continued faulty line of logic. "Our experience also shows that we cannot ignore people who are HIV-negative," she writes, "and we are much more likely to reach those people with prevention messaging in community settings rather than clinical ones. Think about it: when was the last time your doctor asked you about HIV, or engaged you in a conversation about sex?"
I rest my case. There are virtually no new HIV diagnoses in Massachusetts because virtually no one is being offered an HIV test in either clinical settings or community settings, whatever those are (town halls? river boathouses? baseball fields?). The sponsor of the original HIV testing legislation from this session, state senator Patricia Jehlen (D-Somerville), estimates that upwards of 8,000 citizens of our Commonwealth are HIV-positive but do not know it because they have not been offered an HIV test. The twisted irony here is that Massachusetts would regain every federal prevention dollar lost, and then some, once the Commonwealth starts testing people in a routine and standardized approach, per the 2006 CDC-endorsed HIV testing guidelines -- in other words, once people start being diagnosed with HIV, which is inevitable. But, pretty please, don't blow your prevention success horn, citing extraordinarily low HIV diagnosis statistics. Time and routine testing will sadly prove this line of reasoning entirely flawed and fallacious.
"When people out there (hand motion to the landscape beyond his office window) are dissatisfied with a certain piece of legislation," he offered, with a peculiar gleam in his eye, "those of us here (hand motion to the inside of the State House) could not be more delighted."
Huh? His reasoning: Not all parties can or will ever agree on a given bill, so the legislature will probably pass a bill to piss off the very people who should not be pissed off and most likely will have to revisit the legislation a few years down the road when its original intended purpose does not have the desired effect.
No wonder the public approval rating of the U.S. Congress and our own state legislature is at an all-time low.
I could not make this stuff up, even if I tried.
Thanks, but no thanks. I'll cook up my own special, and will let you know the ingredients and recipe once it's been concocted. Stay tuned.
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An Accidental Activist
Ed Perlmutter was diagnosed with HIV in July 2006, and has been receiving HIV therapy through a National Institutes of Health (NIH) study since September 2006. He lives with his partner in an old farmhouse on the city limits of Boston, in the woods, amongst critters and varmints and dozens of varieties of dahlias. When he is not raising awareness as an accidental activist, he is a graduate student in health communication at Emerson College and works as a textbook publishing consultant.
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April 12, 2013 - My Shifting Seat on the HIV Merry-Go-Round: A Blog Entry by Ed Perlmutter
September 10, 2012 - Start Where You Are, Use What You Have, Do What You Can: A Blog Entry by Ed Perlmutter
April 5, 2012 - Simmer on Low; Stir Occasionally: A Blog Entry by Ed Perlmutter
December 2, 2011 - Massachusetts HIV Testing Policy in 2012: Six Degrees of C. Everett Koop -- A Blog Entry by Ed Perlmutter
September 8, 2011 - I'll Take the Paradigm Shift. Can You Super Size It Please? A Blog Entry by Ed Perlmutter
Ed's Posts on TheBody.com's Positive Policy Blog:
August 18, 2010 - Massachusetts "Opt-Out" HIV Testing Bill: Update
July 29, 2010 - Massachusetts HIV Bill Must Pass by July 31
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