HIV Test for Everyone?

September 21, 2006 9:34 AM

CDC Recommends it for Everyone between 13 and 60 This seems like a very expensive proposition. It appears more people are living with this virus without knowing about it.
posted by henryw (57 comments total)

I did it, we all should. Neg, btw.
posted by parmanparman at 9:38 AM on September 21, 2006

What about HIV negative virgins who have never had blood transfusions?
posted by brownpau at 9:50 AM on September 21, 2006

they could have gotten it from their mom
posted by Red58 at 9:52 AM on September 21, 2006

HIV/AIDS has such a stigma, this might be unlikely. Going to get tested for it means you've been up to all sorts of sinful things, obviously.
posted by luftmensch at 9:52 AM on September 21, 2006

What about people who practice abstinence? May be one way to limit the expense. The article just generally assumes that everyone who's between the ages of 13 and 60 (60 in the headline, 64 in the article...either way) IS engaging in some kind of conduct (I assume usually sex or needle use of some sort) that transmits the disease. They could probably cut out at least some sub-set if they just extended the qualification from age to age and sexually active, for starters.
posted by allkindsoftime at 9:52 AM on September 21, 2006

BTW, as far as I understand it, AIDS isn't going to sit dormant in a child from birth until age 13. I'm assuming that's part of the reason they made that the minimum age - long enough to determine that they didn't contact aids from the mother.
posted by allkindsoftime at 9:54 AM on September 21, 2006

"No, hon, I don't need to get tested. I was a virgin when we met and have been faithful ever since. Trust me!"
posted by rogue haggis landing at 9:56 AM on September 21, 2006

What about people who practice abstinence?

Isn't it the case that people who practice abstinence generally don't?
posted by Artw at 9:59 AM on September 21, 2006

i do not have teh aids.
posted by StrasbourgSecaucus at 10:01 AM on September 21, 2006

I'm in UR body killin' UR immune syztim!
posted by blue_beetle at 10:03 AM on September 21, 2006

Seriously, a lot of people are going to lie about sex and drugs. The way it is now, getting tested means admitting that there is some chance you might be positive, which you often can't do. I imagine me at 17 if I'd wanted to be tested, having to basically admit to my dear old family doctor that I had had sex -- not possible! If testing becomes more routine then this isn't an issue. No more stigma than a TB test.
posted by rogue haggis landing at 10:07 AM on September 21, 2006

Just tested 2 weeks ago, negative thankfully. Though the immigration application for which this test was conducted was denied.
posted by trol at 10:08 AM on September 21, 2006

I knew a woman who worked for a state department of health doing outreach and education programs about sexually transmitted diseases. She said the most frequent thing she heard from kids was: "AIDS? I thought we cured that."

Just get tested is a good message to send. Already in this thread there are a half-dozen excuses of why not to. People are good at making excuses and rationalizing away risk instead of reducing risk. Just get tested, you and everybody else.
posted by peeedro at 10:16 AM on September 21, 2006

I'm not sure I buy the 'just get tested' argument. There are an astoundingly large number of other diseases that I'm at far higher risk for than AIDS. Should I get tested for each of them, as well?

I think the CDCs plan as covered in the article (which is nowhere near 'everyone should go out and get tested) isn't necessarily a bad one, depending on the incremental cost of doing an HIV test when doing other blood tests anyway.
posted by jacquilynne at 10:30 AM on September 21, 2006

Jacquilynne— First off, as addressed above, the stigma of testing (and admitting that you're having risky behaviors) is something that while not unique is particular to this virus. Second, it's not even a blood test anymore. (Though when I got my blood drawn for a test regarding tonsilitis, they offered to test it for AIDS as well, so I said "sure.")
posted by klangklangston at 10:36 AM on September 21, 2006

I was under the impression that this was a bad idea, due to the high false postive rate that would result from testing those not at particular risk... Wikipedia - Bayes' Theorem. Does anyone know how accurate HIV tests are these days? And what the current percentage of infected in the US is?
posted by Bugg at 10:41 AM on September 21, 2006

I too am not sure about the "just get tested" arguement.

What if a person has never had sex or used recreational drug needles, and their mother never had AIDS?

Why should they be tested?
posted by allkindsoftime at 10:42 AM on September 21, 2006

I just hope they don't dumb down the test. I want it to mean something when I pass.
posted by srboisvert at 10:45 AM on September 21, 2006

CDC actively advocate testing where I live, so it makes sense they should recommend it at home too - it would make it more difficult for them to be labelled as hypocrites when they recommend the same thing at home as they do abroad.
posted by davehat at 10:45 AM on September 21, 2006

I'm sure that the people that truly have never had sex can simply tell their doctor, "I've never had sex, I don't need your test."

Otherwise, I don't see the harm. Do you all trust every sex partner you've ever had to be 100% honest about their sexual history, and their partners to do the same, etc?

Make it standard and avoid the worry as well as the stigma.
posted by thebatmanager at 10:54 AM on September 21, 2006

It's a good idea and will definetly help stop the spread of the disease. I think people, for the most part, are just scared.

Also, what's the false positive rate for this test?
posted by delmoi at 10:55 AM on September 21, 2006

I too am not sure about the "just get tested" arguement.

What if a person has never had sex or used recreational drug needles, and their mother never had AIDS?

Why should they be tested?

They should be tested, not for any reason that benefits themselves, but for more broad social reasons. Namely, they provide cover for those who should get tested, but can't admit that they need to get tested. For a lot of people, going to get an AIDS test essentially means admitting promiscuity, cheating, or drug use to sex partners, parents, or others. This is a strong disincentive for the people most at risk. If everyone were expected to get tested, whether through legislation, grassroots efforts, or social norms, these people could get tested without ruining their relationships.

Unfortunately, if you make people choose, a whole lot of them aren't going to get tested.
posted by SBMike at 11:11 AM on September 21, 2006

> This seems like a very expensive proposition.

They're certainly not going to pay to do careful ELIZA and Western Blot tests on everybody. They'll have some kind of cheap-shit substitute that misses cases and also throws up a lot of false positives that ruin people's lives (just try getting health insurance after you've tested positive for HIV. And try getting a false positive off your record.)
posted by jfuller at 11:19 AM on September 21, 2006

It also goes without saying that this is only a partial solution, and combatting AIDS must include robust sex education that includes learning about all forms of birth control and disease prevention (yes, that includes condoms as well as abstinence).
posted by SBMike at 11:24 AM on September 21, 2006

Bugg, you are correct. There would be a great many false positives if testing is instituted across the board, even if the error rate is very low.
posted by sonofsamiam at 11:27 AM on September 21, 2006

The solution is to require multiple tests when one comes back positive, right? I've heard it's already standard to do a second in the event of a positive result; maybe with the change in prior distribution that would result from this policy, another would make sense.
posted by grobstein at 12:24 PM on September 21, 2006

Castro quarantined HIV+'s early on, and even though that's no longer the case, questions remain about treatment, medical and social, there-- and its quite a bit more than a bridge too far to imagine that the Bush administration wouldn't make some use of this information if it had it; they could argue that Homeland Security would need to have the list because HIV+'s would be so much easier to recruit as suicide bombers, for instance; and I think it would drastically reduce public support for effective treatments to help HIV+ people live happy long lives.
posted by jamjam at 12:33 PM on September 21, 2006

HIV+'s would be so much easier to recruit as suicide bombers

Yikes, jamjam, you'd make a great insurance claims adjuster.
posted by sonofsamiam at 12:36 PM on September 21, 2006

I don't get why (some) people are so resistant to getting tested. I've been tested several times since I first became sexually active, and even a few times in the 4+ years I've been in a monogamous relationship. Not only for HIV/AIDS either, because I know that there are other STI's that I'm more likely to contract because they're more common. I realize that what I don't know CAN hurt me, and I think more complete knowledge of my own health is always better than less. So I treat a full STI screening as a routine part of my medical care. This makes sense to me. Wouldn't you rather know?
posted by raedyn at 1:13 PM on September 21, 2006

I think it would drastically reduce public support for effective treatments to help HIV+ people live happy long lives. - jamjam

What's your reasoning for that? On first blush, I think the opposite.

Extended screening would catch a lot more of the people that are infected and that do not fall into the current 'high risk' categories. We'd have more hard numbers about who (demographically) is infected, and maybe the picture would look different that what we think it is now. If more people discover that it's not just 'sluts, druggies & gays' infected, perhaps they could relate to AIDS victims and therefore support improving quality of life for people living with HIV/AIDS.

I haven't thought about it deeply, but that's what occurs to me.
posted by raedyn at 1:27 PM on September 21, 2006

In terms of only getting tested if you've had sex or injected drugs, there's also the issue of what you define as "sexually active."

And I'm guessing the highest-risk populations define it differently than you do.
posted by oliver at 1:49 PM on September 21, 2006

They should be tested, not for any reason that benefits themselves, but for more broad social reasons. Namely, they provide cover for those who should get tested, but can't admit that they need to get tested. For a lot of people, going to get an AIDS test essentially means admitting promiscuity, cheating, or drug use to sex partners, parents, or others.

Are you for serious? So if I decided, for whatever reasons, NOT to have sex or use drugs, I have a social obligation to get tested for something I KNOW that I do NOT have, because other people do decide to do these things?

Sorry, not buying that.

If they are going to decide to shoot up or sleep around, then they assume all obligation for the testing. Don't put it on people who decided to not engage in the at-risk activities.

Broad social reasons...sheesh...
posted by allkindsoftime at 1:56 PM on September 21, 2006

If they are going to decide to shoot up or sleep around, - allkindsoftime

This jumped out at me. You don't have to sleep around in order to contract HIV/AIDS. You only need to have sexual contact (which is, of course, not limited to penetrative intercourse) ONCE in order to get infected.

I think a lot of people already choose not to get tested because they vaguely believe that you must "sleep around" in order to be at risk. (That's the sluts/druggies/gays stereotype I talked about in a previous comment).

Just because you THINK you aren't at risk doesn't mean you're right, unless you completely abstain from sexual contact.
posted by raedyn at 2:24 PM on September 21, 2006

Are you for serious? So if I decided, for whatever reasons, NOT to have sex or use drugs, I have a social obligation to get tested for something I KNOW that I do NOT have, because other people do decide to do these things?

OK, but how many people can actually KNOW that they do NOT have the disease without being tested? Only if somebody has stayed completely abstinent can they be sure. Using condoms is no guarantee, nor is being in a committed long-term relationship.

If you are strong enough of character to actually stick to abstinence only (without engaging in anal or oral sex either), then testing is a waste on you. However, how many stories have we heard about broken abstinence pledges? They don't work generally, and the illusion that they somehow do is vastly harmful to everyone. Unfortunately, many people would rather risk infecting others than to come clean to partners or parents.

I wish I lived in your fantasy world where people behaved responsibly, and that everyone that didn't behave responsibly was at least responsible enough to get tested and halt any further spread. As it stands, I think removing the stigma and suspicion from testing is our best defense for when reality pops in to remind us that humans are not infallible, and are rarely honest with themselves, let alone others.
posted by SBMike at 2:25 PM on September 21, 2006

I wish I had more reasons to need to get tested...

I was at a lab that made and used their own tetramers. The positive control for each batch was a tetramer against that/previous year's influenza and the negative control was against HIV. The specificity of these tetramers are impressively high.

One time I tested positive for HIV. I knew it was a false positive but I was still shaken up until they tested my blood against a new batch.

I couldn't help myself but the thought that "since I've got, basically, this death sentence, I'm going to give it to as many people as I can." Shameful thought, but I have to admit that it crossed my mind.

Aside from paying for the initial cost of the screening, who's going to pay for treatment, and more importantly, counseling?

Also, seropositivity doesn't necessarily mean that there's virus. I know someone who worked in a HIV research lab and although he has not been infected with the virus, he has some immune reactivity against HIV coat proteins (which is what the ELIZA tests for - the presence of antibody against HIV coat proteins).

The cross-board screening of HIV isn't a bad idea per se, but the devil will be in the details on how to execute this plan and the subsequent consequences.
posted by porpoise at 3:05 PM on September 21, 2006

One problem people don't seem to've pointed out yet is that HIV is especially common amongst poor people, who tend not to have health insurance, and thus not see doctors regularly. How will health care workers reach these people to adminster the tests?
posted by Pseudoephedrine at 3:32 PM on September 21, 2006

Bugg's comment is excellent, and is more fully explained here.
posted by Mr. Gunn at 3:47 PM on September 21, 2006

How will health care workers reach these people to adminster the tests?

The article mentioned making it a standard part of emergency room tests - which is where a lot of non-insured people end up because they don't see regular doctors.
posted by jacquilynne at 3:59 PM on September 21, 2006

Isn't it the case that people who practice abstinence generally don't?

Um, no? How do you practice abstinence and at the same time not abstain from it? Preach it and not be a virgin, I could see...
posted by jmd82 at 4:51 PM on September 21, 2006

Your blood is tested for the HIV virus everytime you donate.

Why not just force everyone to donate blood?

That thing about emergency room tests is fucked up.

Patients would be allowed to decline the testing.

But I'm cool with that.
posted by mrgrimm at 4:54 PM on September 21, 2006

No more stigma than a TB test.
posted by rogue haggis landing at 10:07 AM PST

Right. If you are allergic to horses and they do a TB test, it comes back positive. Then you have to get the chicken-based test. The fools won't even believe you when you ask 'is this the horse test...because you'd better give me the chicken test from the get-go.' To say "no problem" is being a tad casual.

The false positive rate and the effects of setting the HIV bit to true in various computer systems are a major issue.

Not to mention if you happen to have a genetic expression that kills HIV and big phara makes a drug off of that....you think you'll get a cut of your DNA in the patent?
posted by rough ashlar at 4:59 PM on September 21, 2006

Why not just force everyone to donate blood?
posted by mrgrimm at 4:54 PM PST

Screw that.
Think it's fantasy? It's already happened and the blood donor lost in court and the company has patented his DNA.
posted by rough ashlar at 5:12 PM on September 21, 2006

Certainly everyone should take an HIV antibody test. The only reason I can think of not to do so is that a positive test won't necessarily be followed by guaranteed health care.
posted by goofyfoot at 6:31 PM on September 21, 2006

while i think it's a good idea for everyone to know their HIV status, i am simply stunned there is not more outrage over the CDC 'urging' HIV tests for everyone between the ages of 13-64. i find it offensive that any government agency 'urge' anyone to be HIV tested. when does 'urge' become 'mandate?' is there name reporting to health departments for those who test positive? is there any guarantee that those who test positive will refrain from sex/safe sex? is treatment guaranteed to those who test positive? why not test everyone for hepatitis B and C, as those are both bloodborne diseases transmitted via sex. i'm afraid this 'urging' will drive people AWAY from healthcare and doctors. it will further drive the disease underground.
posted by brandz at 6:51 PM on September 21, 2006

I'm not sure why they couldn't achieve 80% or so of the same public benefit at 20% or so of the cost by just expanding the risk factors matrix.
posted by dhartung at 7:37 PM on September 21, 2006

"HIV+'s would be so much easier to recruit as suicide bombers"

Oh please. I know from experience in a big city (but not NYC or SF) ACT UP chapter in the 1980s -- when being poisoned with AZT was usually the only treament option available -- that HIV+ people are hard to recruit even for a demonstration in favor of advocating less poisonous treatment options.

As for testing, I've insisted on being tested several times for several things over the years: as of a couple years ago I was negative for HIV, Hepatitis A and C, TB and syphilis, that I still have antibodies to Hepatitis B (as a teenager a lover told me I should get tested; I never felt ill) so I'm probably immune (but ain't about to push it), and my cholesterol is so high that it's probably genetic (and I'll wait to treat that till they find better drugs than those statin poisons that made me feel ill). That said, if HIV is such a public health problem I think lessening the stigma on testing might be a good thing -- and in any case I don't think that quarantining HIV+ people who won't or can't resist spreading it is such a bad idea as "quarantine" need not mean "Auschwitz".

And yes, as I figure that if you must have a government you might as well make it give us universal health care, of course people who test positive should have the option of guaranteed treatment, for free if they can't afford it, just as lack of ability to pay should not be a bar to any other kind of necessary health care. (But elective plastic surgery should be frigging expensive for everybody.)
posted by davy at 8:55 PM on September 21, 2006

I'm all for less expensive testing; while living in SF we had to lie and say we were gay in order to qualify as "high-risk" and get free testing.

When I went to planned parenthood they looked at me like i was crazy to get a test.

"You've been in one new monogamous since you've last been tested? You're not a needle user? Hmm..... ok......."
posted by dentata at 12:25 AM on September 22, 2006

brandz writes "i am simply stunned there is not more outrage over the CDC 'urging' HIV tests for everyone between the ages of 13-64. i find it offensive that any government agency 'urge' anyone to be HIV tested. "

The CDC also urges things like eating well, refraining from using drugs, etc. It's a matter of health and disease, and that's what, y'know, the CDC is for.

The fact that any of you are even questioning the utility of this is the most grossly stereotypically American attitude I can think of. Ain't gonna let no gubmint tell you what to do, no sir! There's an erroneous feeling in the gay community these days that HIV is simply a manageable condition, like diabetes, so why worry about safe sex? Simple: diabetes isn't contagious, and diabetes won't kill you as long as it is managed correctly. HIV will kill you, sooner or later.

Everyone should be tested, under the same laws that currently govern testing--namely, that it's private. People need to know that they're positive, and hopefully get some education about safe sex--although we all know what your barbaric government thinks about that.
posted by dirtynumbangelboy at 4:12 AM on September 22, 2006

Diabetes, and complications thereof, will kill you. It can be managed for a long time, but it basically lops at least 10 years off your total life expectancy.
posted by klangklangston at 6:08 AM on September 22, 2006

Isn't it the case that people who practice abstinence generally don't? - Artw

Um, no? How do you practice abstinence and at the same time not abstain from it? Preach it and not be a virgin, I could see... - jmd82

I think Artw is refering the following information:

According to a study released March 9, 2004 at the National STD Prevention Conference, 88% of 12,000 teenagers who had pledged to remain abstinent until marriage reported having had sexual intercourse before they married. "Pledgers" also had STD infection rates comparable to their peers who did not take virginity pledges. Although they delayed intercourse for up to 18 months, when they became sexually active, teenagers who had signed pledges were less likely to use condoms and less likely to seek medical help for STD infections than their peers.(Source)

My link is not to a primary source, but it's the reference to that study that I could most quickly google. There are additional informative links after the jump.
posted by raedyn at 8:56 AM on September 22, 2006

Factors known to cause false positives on HIV antibody tests:

* Anti-carbohydrate antibodies
* Naturally-occurring antibodies
* Passive immunization: receipt of gamma globulin or immune globulin (as prophylaxis against infection which contains antibodies
* Leprosy
* Tuberculosis
* Mycobacterium avium
* Systemic lupus erythematosus
* Renal (kidney failure
* Hemodialysis/renal failure
* Alpha interferon therapy in hemodialysis patients
* Flu
* Flu vaccination
* Herpes simplex I
* Herpes simplex II
* Upper respiratory tract infection (cold or flu
* Recent viral infection or exposure to viral vaccines
* Pregnancy in multiparous women
* Malaria
* High levels of circulating immune complexes
* Hypergammaglobulinemia (high levels of antibodies
* False positives on other tests including RPR (rapid plasma reagent test for syphilis
* Rheumatoid arthritis
* Hepatitis B vaccination
* Tetanus vaccination
* Organ transplantation
* Renal transplantation
* Anti-lymphocyte antibodies
* Anti-collagen antibodies (found in gay men haemophiliacs Africans of both sexes and people with leprosy
* Serum-positive for rheumatoid factor antinuclear antibody (both found in rheumatoid arthritis and other autoantibodies
* Autoimmune diseases : Systemic lupus erythematosus scleroderma connective tissue disease dermatomyositis
* Acute viral infections DNA viral infections
* Malignant neoplasms (cancers
* Alcoholic hepatitis/alcoholic liver disease
* Primary sclerosing cholangitis
* Hepatitis
* "Sticky" blood (in Africans
* Antibodies with a high affinity for polystyrene (used in the test kits
* Blood transfusions multiple blood transfusions
* Multiple myeloma
* HLA antibodies (to Class I and II leukocyte antigens
* Anti-smooth muscle antibody
* Anti-parietal cell antibody
* Anti-hepatitis A IgM (antibody
* Anti-Hbc IgM
* Administration of human immunoglobulin preparations pooled before
* Haemophilia
* Haematologic malignant disorders/lymphoma
* Primary biliary cirrhosis
* Stevens-Johnson syndrome
* Q-fever with associated hepatitis
* Heat-treated specimens
* Lipemic serum (blood with high levels of fat or lipids
* Haemolyzed serum (blood where haemoglobin is separated from the red cells
* Hyperbilirubinemia
* Globulins produced during polyclonal gammopathies (which are seen in AIDS risk groups
* Healthy individuals as a result of poorly-understood cross-reactions
* Normal human ribonucleoproteins
* Other retroviruses
* Anti-mitochondrial antibodies
* Anti-nuclear antibodies
* Anti-microsomal antibodies
* T-cell leukocyte antigen antibodies
* Proteins on the filter paper
* Epstein-Barr virus
* Visceral leishmaniasis
* Receptive anal sex
posted by snakey at 12:08 PM on September 22, 2006

"Factors known to cause false positives on HIV antibody tests..."

Damn.
posted by Twang at 5:21 PM on September 22, 2006

Your blood is tested for the HIV virus everytime you donate.

Why not just force everyone to donate blood?

The Red Cross makes it clear that you should -not- donate blood in lieu of getting tested--if you actually have reason to suspect that you've been exposed to HIV (as opposed to "oh, everyone should get tested just in case"), don't donate, because the tests aren't perfect and you may expose someone else to HIV.
posted by needs more cowbell at 12:05 AM on September 23, 2006

You could get a false positive from eating a piece of BREAD (anti-carbohydrate antibodies) -- but go on and get tested -- it may ruin your life with a false positive, but it's good for their stock price anyway. . . (even though Orasure has a notoriously bad PPV)
posted by snakey at 2:30 AM on September 23, 2006

To remind everyone, Snakey is our resident HIV-denier. You'll find him in all of the AIDS threads spouting pseudoscience and polemics. I would not trust his "data," as he's been debunked so many times that he makes Bevets look empirical.
posted by klangklangston at 6:14 AM on September 23, 2006

"Factors known to cause false positives on HIV antibody tests: ... * Receptive anal sex"

Funny, that's one of the main factors that cause TRUE positives too. Using condoms reduces the risk quite a bit.

It's also strange that I have or have had several of his listed factors and still tested negative for HIV -- like, even after I ate bread with a cold sore on my lip during a mild flu (or something, it obviously turned out not to be the dreaded Final Count-Down).

The point is, there are still far more true positive results than false ones, 25 years after we started saying "use condoms and don't share needles". I wonder why.
posted by davy at 10:10 PM on September 25, 2006

_{Sheesh, no one read my link. (No wonder, I pasted the wrong URL!) This is the correct link. I thought the math scared you all off.}
I'll summarize the idea, briefly. I'm all for everybody getting tested, but you have to understand something first.

If you do a home-screening or rapid screening test, without screening for risk factors first, the results on any given person are 2-4 times more likely to be a false positive than a true negative. According to the CDC's rapid testing document, the positive predictive value of the rapid screening kits ranged from 25% to 60% in the general population. This means that if you're not high-risk, only 25% to 60% of the time when the test is positive do you actually have the disease. If you look at the high risk group, however, the PPV goes up to 92-97%.

The tests are made extremely sensitive, and rightly so, because it's much worse to tell someone they don't have it when they do than the other way around. However, this means that as you start testing more people, you're going to be generating literally hundreds of millions of false positives, which will then have to be re-tested by ELISA and Western Blot to be ruled out. In which case, why did you bother with the rapid screening at all?

So, in summary, everyone should be screened for risk factors, mandatorily tested if they're high risk, and given the option to pay for the ELISA + Western Blot testing if you're not high-risk. This will catch everyone except those who lie about which risk factors they have. Undoubtedly many people will, but until someone ponies up the cash to do ELISA and WB on everyone in the less-than-high risk group, you can't catch those people. Even if you do manage to get the money to do this, you bump up against the unpleasant reality that the money available for AIDS prevention and treatment is finite, which leaves you asking whether spending all that money to catch the .1% of people who are false negative is really the best overall use of a finite amount of funds. It sucks that we have to make these kinds of decisions, especially when we're spending far, far more to prevent something of far, far less risk.
posted by Mr. Gunn at 9:18 PM on September 27, 2006