Plan for routine universal AIDS testing draws strong reaction

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8/14/2006  

TORONTO ? A push to make HIV tests as routine as a test for high blood pressure provoked a backlash here Monday from opponents who say AIDS' lingering stigma makes the risk of disclosure too great, especially when many patients still can't get access to treatment.
But doctors who treat AIDS patients say the risks of people not knowing whether they are HIV-positive are greater, because those who are diagnosed with the disease in its late stages die within months and people who get treatment can survive for decades. Studies also show that people who test positive change their behavior and are much less likely to infect others.

"We've had 40,000 new cases in the USA a year for 16 years, and we haven't made a dent in that," John Bartlett of Johns Hopkins University said at the 16th International AIDS Conference. "It's a no-brainer. You have to test."

The U.S. Centers for Disease Control and Prevention circulated draft recommendations in March calling for routine HIV testing without specific consent in all doctors' offices, clinics and hospitals, unless patients explicitly refuse or "opt out." Final recommendations will be published Sept. 22, says the CDC's Timothy Maestro, an architect of the proposal.

The World Health Organization and the United Nations Programme on HIV/AIDS also are clamoring for more widespread testing. They propose that doctors and nurses recommend that even healthy-looking patients get tested while allowing them to decline.

"It's estimated that no more than 10% of people around the world know whether they have an infectious disease for which effective treatments are available," says Kevin De Cock, head of WHO's AIDS program. He adds that treatment programs can't expand without more testing, but the results must remain confidential and appropriate counseling must be provided.

But India-based human rights lawyer Anand Grover, project director of the Lawyers Collective HIV unit, says he fears that doctors' supreme authority in the developing world probably will lead many to simply order tests without consent.

Last week, the non-profit Human Rights Watch issued a report condemning testing policies in many nations. For example, it said, Saudi Arabia tests foreign workers, confines those who are positive and then deports them.

A few dozen protesters at Monday's meeting marched with signs, chanting, "We need more than just a test." Julie Davids of the Community HIV/AIDS Mobilization Project said the protesters objected to "scaling up testing without an immediate scale-up of treatment."

Jodi Jacobson, director of the Center for Health and Gender Equity, says developing countries also must combat the stigma of HIV. "There are many issues in the debate in the U.S. that are magnified a million times over internationally because there are fewer protections in place," she says. "Just couple of weeks ago, a 12-year-old boy in Mysore (India) was tied to his bed by doctors who tested him for HIV."
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