HIV Testing: Does It Contribute to Stigma?

Within the first year of my diagnosis, a close friend who worked in the medical field had an exposure to bodily fluids and had to go for testing. They knew my status, and in telling me the story very innocently said that they had to go to the "Whore House" for the tests. WOW! I initially was very upset about the implications of this statement -- in effect calling ME a whore. But the intentions of the person were not leaning this way at all; they were just using a term that was common in their place of employment without thinking about the implications. After some time passed, my wounds healed and I began to wonder just WHY this term was so common.

And then it struck me. In getting tested myself, I had to go through "pre-counseling" -- a process that is intended to educate people regarding their "risks" for HIV exposure and also to help the public health folks track the epidemic. After all, we use this data extensively in trying to tailor messages and reach people who may be likely to be exposed to the virus. So I know the value of the thing. But strictly speaking from a patient’s perspective, all those questions are really pretty exhausting. I can see how, if a person ended up testing negative, they would think that perhaps somebody testing positive had to have done ALL of the things on the list. And that leads to some assumptions about people who test positive for HIV.

I think it also leads to some fear for people to be tested themselves -- and gives people especially in the health care setting some unrealistic opinions regarding their own risks. I can hear them thinking "If I only check one of the 'risk' boxes then I must be okay. No need to be tested. And I can look down on people who do get tested or reveal their positive status.

This makes me wonder if it would be helpful to offer routine HIV testing along with annual physicals. As a woman, I get a Pap smear each year. Whether or not I think I might have been infected with any of several STIs, I am tested for them. Why not just add HIV to the list? I can also imagine a list of blood tests to watch -- blood sugar, cholesterol levels, and HIV. No big deal. If a result comes back positive, that would be a good time to trace back infections and make sure the person has access to health care.

I know there are some complicated emotions involved in all of this. But really, I think this measure would decrease barriers to testing, increase the number of people who know their status early on and thus have access to treatment and a healthier life. I also happen to think it would help to reduce the stigma associated with this virus. After all, if everybody is tested then people might actually start to realize the truth: This virus does not discriminate. ANYBODY can be infected.

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