Truth in Numbers

Frontdesk by David Waggoner

How can you underreport the AIDS epidemic? New York City admits that it did. Ironic, since now getting tested for HIV has never been easier and might become as routine as going to see the doctor. What’s happening? Well, for one, the Centers for Disease Control and Prevention (CDC) has been pushing—for a long time—that everyone get tested when they go for a flu shot, a physical, even a tummy ache. This voluntary screening of everyone from thirteen to sixty-four is ill-advised unless Congress votes to radically increase funding for early treatment. What good is it to “increase” the HIV caseload if the states and the feds don’t have enough money to treat the increased caseload? Go figure.

Although medical records are kept confidential, and family members aren’t told the serostatus of even their own adult children, there are reasons to worry about the civil rights of patients in this newest frenzy to get everyone tested. No finger-pointing, no identification, no Big Brother, please. But still the idea persists (for some) that once you’ve tested positive (or negative for that matter), you’re going to be put on some list. Sounds like the future? Not really. It’s happening today. Not necessarily by the government, although many insist that those fears are well-grounded.

As routine as a doctor listening to your heart or a nurse taking your blood pressure, this new “get tested, feel happy” attitude could fall into the hands of the wrong sort of folks. Insurance companies, right-wing fanatics, even conservative school districts could use the excuse to try to enforce, by way of the family physician, attitudes and misconceptions that are not conducive to the civil rights of those found to be positive.

So here we go again. Fear-mongering rather than medical soundness is bound to tie up more money than ever before to test segments of the population who are already doomed by the lack of pediatric HIV medications. Testing the young and testing the old is not a way to accurately report the HIV crisis in this country. Or to treat it. And universal testing (even if it is, in effect, voluntary) doesn’t guarantee that the groups with the highest infection rates and health risks will be properly counseled. With all this extra information what is going to happen if someone does find out that they are infected but doesn’t have
the helping hand of big government to go it alone?

There isn’t enough money presently allocated in the federal budget to push for this. Granted, over 250,000 Americans are living with HIV and don’t know they have the virus. That fact doesn’t qualify for wholesale testing unless our politicians adequately fund AIDS education, prevention, and treatment programs. It just doesn’t make sense to promote a new “get tested to be well” paradigm when prevention counseling, in the words of the CDC itself, “should not be required with HIV diagnostic testing or as part of HIV screening programs in healthcare settings.” Whoa. That’s a lot like what they do in prisons, but worse. For everyone else, the CDC states: “Screening should be incorporated into the general consent for medical care; separate written consent is not recommended.” That’s scary.

In these strange times, now I can understand how New York City—needing more funds than ever to treat the city’s expanding numbers of those living with HIV and AIDS—might want to test as many people as possible. With little or no increase in federal funding, there’s going to be a rush for big cities like New York to test and test and test again before the treatment money runs out. There’s going to be a race to see which state or municipality can get a bigger piece of the pie. But with this overzealous need to test for positives, who wants to go near a clinic these days? Not the people who need to get tested the most.

Ocotber 2006