Kaisernetwork.org (Washington, DC)
21 November 2008
Public Health & Education
CDC's HIV Testing Recommendations Not Being Followed, Studies Show
[Nov 21, 2008]
Two years after CDC recommended routine HIV testing for people ages 13 to 64, several studies presented at a recent conference indicate that the recommendations generally are not being followed, the Washington Post reports (Brown, Washington Post, 11/21). According to the Baltimore Sun, researchers at the Forum for Collaborative HIV Research -- based at the George Washington University School of Public Health -- said on Thursday during the conference that HIV testing is a significant step to ending the epidemic in the U.S. About 1.1 million people are living with HIV in the U.S. and one in five is unaware of his or her status. The researchers also said that people who are unaware that they are HIV-positive are responsible for transmitting 50% to 70% of new sexually transmitted infection cases. John Bartlett, chief of infectious diseases at Johns Hopkins University School of Medicine and a co-chair of the meeting, said the high number of people unaware of their HIV status should be a "call to action that the test will be offered on a more regular basis" (Brewington, Baltimore Sun, 11/21).
According to the Post, the studies show that the most common reasons for not following CDC's recommendations are misconceptions by clinicians that the tests take too much time, as well as an unwillingness by health insurers to pay for the tests. Kevin Fenton -- director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention -- said, "Reimbursement is a major barrier to routine testing." The Post reports that testing a patient who receives an initial saliva test, followed by a blood test for confirmation if possible, costs about $80 to $120 if the patient is charged (Washington Post, 11/21).
The Sun also reports that a continuing stigma associated with HIV/AIDS is contributing to a lack of widespread testing. Richard Rothman, associate professor in Johns Hopkins University's Department of Emergency Medicine, said 2006 data show that emergency departments tested patients at a rate of 3.2 tests per 1,000 visits. "There are many missed opportunities in recognizing patients earlier in the course of their illness," he said (Baltimore Sun, 11/21). Veronica Miller, executive director of the forum, said that HIV/AIDS is a "life-threatening disease that is so grossly underdiagnosed and undertreated in this country." She said that about 5% of patients presenting with serious illness are routinely tested for HIV in hospital EDs. For example, at John H. Stroger Jr. Hospital of Cook County in Chicago, about 2,000 people who went to the ED and were ill enough to be admitted were offered HIV tests. Slightly less than 1% tested HIV-positive, and more than 90% had CD4+ T cell counts less than 200, one of the factors that leads to an AIDS diagnosis (Washington Post, 11/21).
According to the AP/Indianapolis Star, 11 states have changed their laws to no longer require special consent for HIV testing, which is a "key step to making an HIV test part of the standard battery that patients expect." People living with HIV are "mostly likely" to be found in EDs because many are uninsured and have low incomes, the AP/Star reports. Bartlett said that routine HIV testing in patients who are not critically ill is given in no more than 100 of the U.S.'s 5,000 EDs, adding that about 40% of pregnant women and their infants who should be tested for HIV are not. "Those are what we call missed opportunities," he said (Neergaard, AP/Indianapolis Star, 11/20).
The studies also show that if routine HIV testing were implemented in the U.S., HIV detection could occur at earlier stages in many people (Washington Post, 11/21). Miller said that it is "crucial to understand how important routine HIV testing is at every level of American society so everyone knows their status; it's the first step in controlling the HIV epidemic" (Tasker, Miami Herald, 11/20). Bartlett said HIV testing today is "much better, it's much easier, it's much cheaper. The treatment is really great now." CDC's Bernard Branson said the agency "find[s] people are very receptive to being tested, and there was concern about that before." He added that "people are taking the recommendations to heart and implementing them as much as was feasible for them." According to the AP/Star, data from the studies presented on Thursday indicate that more than 80% of ED patients were "amenable" to HIV tests and that most ED staff were opposed to administering the tests. This is "[p]resumably because [EDs] are so busy, and there is confusion on how much HIV counseling is needed," the AP/Star reports. There are no nationwide data on the impact of the new guidelines, according to Branson (AP/Indianapolis Star, 11/20).
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Election 2008
Advocates Rally at White House, Urge Obama To Prioritize HIV/AIDS
[Nov 21, 2008]
More than 1,000 HIV-positive people and HIV/AIDS advocates gathered near the White House on Thursday to urge President-elect Barack Obama to improve both domestic and global HIV/AIDS initiatives, VOA News reports. The rally was coordinated by Africa Action.
Michael Swigert, associate director of Africa Action, said that Obama's first 100 days in office will be "a critical period" for setting HIV/AIDS priorities, including appointing the next U.S. global AIDS coordinator and other global health positions. Swigert said that it is "important that Obama fill those positions with qualified individuals who support comprehensive prevention programs." According to Swigert, President Bush's HIV/AIDS work is "probably his most popular foreign policy" and has generated "good will for us abroad." Under the next administration, the U.S. should "continue to be a leader" in these efforts, he said.
According to Swigert, HIV/AIDS funding should be a priority for the next president as well as the next Congress. He acknowledged that current economic conditions will pose challenges for the next administration to fund expanded HIV/AIDS initiatives but said that the U.S. "need[s] to provide $59 billion over five years" through the President's Emergency Plan for AIDS Relief "to fight not just HIV but also malaria and tuberculosis." Swigert added that the U.S. will need to set "hard treatment targets" and increase the availability of generic drugs to meet the goal of achieving universal treatment access by 2010. Although PEPFAR has done "an increasingly better job" of not relying on brand-name medications, the program "still could do better in stretching taxpayer dollars further to save lives in Africa," Swigert said. According to Swigert, there is a "big push" in the U.S. development community to "consolidate development assistance" and "harmonize" the funding of development programs in Africa. Therefore, it is "really important" for Obama to build on his "incredible popularity" by enlisting U.S. allies in Europe to address issues like HIV/AIDS "that really affect Europeans, Americans as much as Africans," Swigert said.
According to VOA News, Obama during the U.S. presidential campaign committed to guarantee treatment and care for HIV-positive people in the U.S., provide housing for people living with HIV, end the federal ban on needle-exchange programs and redirect abstinence-only education into broader HIV prevention programs. In addition, Vice President-elect Joe Biden in July helped pass a bill to reauthorize PEPFAR in Congress, VOA News reports (Lesser, VOA News, 11/20).
An audio discussion with Swigert is available online.
Link to this story.
Public Health & Education
About Half of Nurses in U.K. Have Experienced Needle Stick Injuries, Many Are Concerned About HIV Risk, Study Says
[Nov 21, 2008]
A recent report by the United Kingdom's Royal College of Nursing found that 48% of the 5,000 nurses polled had been injured by a needle previously used on a patient during their careers, with about one-third fearing risk of exposure to bloodborne diseases such as HIV and hepatitis, BBC News reports (BBC News, 11/19). According to the PA/Google.com, the survey also found that although most nurses who had experienced a needle injury were provided with information about risks from their employer, 28% were not. In addition, about one-third of nurses within the National Health Service who had experienced an injury regarded the support they received from their employer as adequate (PA/Google.com, 11/19). According to BBC News, one-quarter of nurses who said they experienced needle sticks reported that their employer did not provide them with post-exposure prophylaxis. In addition, a poll of nurses in the report revealed that nearly half of the nurses do not have access to safety devices, such as shielded needles, that could protect nurses from infections like HIV and hepatitis, RCN said.
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