World AIDS Day: Surprising finds, new HIV testing recommendations
by James Hubbard, M.D., M.P.H.
The World Health Organization established World AIDS Day in 1988 to be observed every December 1 in order to raise awareness for the HIV/AIDS. You may be thinking it needs no more awareness, and you may be correct.
For a while, AIDS was publicized as the scourge of the earth, the plague that would bring down civilization, the scare of the century, if you will. But then modern medicine stepped in and does what it does best, make medicine for it.
Since then, there have been newer scares (the media is always looking for the freshest scare of the day to get your attention), Magic Johnson looks strong and healthy after announcing he was HIV positive over 15 years ago and it is rare to hear that a public figure has died of the disease. Many young people think of it as just another STD, if they think of it at all.
But a funny thing happened along the way.
It is still killing thousands a year. New problems are cropping up, such as twice the risk of cancer in those with the disease—and I don’t have room to go into the tremendous financial costs. In the U.S., over one million have HIV/AIDS, with 56,300 new cases in 2006 alone. Why is the number still growing?
Here’s where awareness collides with complacency. About 25 percent of people who are HIV positive don’t even know it. There are no early symptoms, and people are not getting tested. I guess they go with “ignorance is bliss.” So they are spreading it to their sexual partners. Because of the stigma associated with the disease, agencies have treaded lightly. Only recently has the CDC recommended testing be done without a formal signature of consent from the patient.
The Annals of Internal Medicine, which is the journal for the American College of Physicians (Internists) now recommends that physicians routinely screen for HIV and “encourage” their patients to get tested. They also recommend annual retesting for high-risk groups, such as:
injection drug users and their sexual partners, persons who exchange sex for money or drugs, sexual partners of HIV-infected persons, men who have sex with men, and heterosexual persons who have had or whose sexual partners have had more than 1 sexual partner since their most recent HIV test.
For the average heterosexual, non-IV drug abusing Jane/Joe, I would think it best to be screened before sex with a new partner, and make sure the partner is screened also. Of course, use condoms. Don’t assume your new partner isn’t infected or it is not romantic, just get the test. ‘Nuff said.
Will physicians follow these new recommendations? I don’t know, but it probably will take a while unless they already routinely screen. Old habits are hard to break.
What do you think?
Read more about the current state of AIDS in our Jan/Feb 2009 issue of JHMFD, out in late December. Dr. Jonathan Zellan, infectious disease specialists, writes about its history, treatment and current trends.
Pictured: HIV virus attached to a white blood cell. (Image courtesy CDC.)
Tags: AIDS, HIV, recommendations
December 2nd, 2008 at 9:04 am
Wow. Sobering. But I think that you’re right. Once the public saw that people with AIDS could continue to live normal lives (like Magic Johnson), attention to AIDS dropped away and other diseases took over the spotlight. I hope that people heed the recommendations of the Annals of Internal Medicine.
Thanks for the informative post.
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December 2nd, 2008 at 10:07 am
Thanks Cathy, me too.
December 2nd, 2008 at 10:27 am
This post is especially timely, given the El Paso County Department of Health and Environment recently terminated its STD program. With no surveillance or efforts to track down contacts, there’s a good chance HIV cases will rise locally and no one will know it.
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December 2nd, 2008 at 10:44 am
Excellent point, Brian. Probably more people were screened there than anywhere else in the county. It would be a good study to document number of new cases, but how can you do that without testing.
Bottom line, if you live in El Paso, be abstinent or wear condoms always(come to think of it, good advice for everyone).
thanks
December 2nd, 2008 at 12:26 pm
As a TV news health reporter for 12+ years, I covered HIV/AIDS many times. The thing that got me was what I learned when I interviewed physicians who specialize in this field - they were concerned because once people knew that AIDS was no longer an automatic death sentence because of the meds for it, they no longer thought of it as a serious disease. And wow - how scary is it that 25-percent of those who are HIV positive don’t even know it. Is it mainly younger people?
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December 2nd, 2008 at 1:49 pm
Thanks for that perspective, FatFighter. I think their worry is coming true.
December 2nd, 2008 at 3:22 pm
This is the sentence that popped out at me. “About 25 percent of people who are HIV positive don’t even know it.” Wow!
December 2nd, 2008 at 4:26 pm
Fatfighter, The Annals article states there were more new HIV positives in 2006 within the 25-44 year old range. They did not speculate on age groups with most undiagnosed cases.
December 2nd, 2008 at 4:35 pm
Amazing huh, Jolene, and scary. The Annals cited past studies showing 10-25 percent of those that tested positive in routine screening reported no high risk behavior. Now dishonesty may play a role but still…