Thursday, November 03, 2011

What's up with HIV testing?

The gains in our life expectancy in the United States have primarily been in the area of public health, not miracle technology, end of life nursing care, pharmaceuticals or screening for disease. Malaria and polio and small pox didn't become footnotes in our history books because people were given choices. When my sister Carol got polio in 1949, the poster quarantining us and warning the whole town went up immediately--even in a rural community.

So I'm wondering why men entering the prison system, who've had most of their rights taken away, have the right to say NO to being tested for HIV. Male to male/men having sex with men (MSM) is still the #1 method of transmission of HIV/AIDS followed by IV drug use. Although MSM represent 2% of the population, they account for 64% of all new infections (including 3% among MSM who are injection drug users [IDUs]). In prison, sex is how you get and return favors. Even men who aren't gay have sex with men in prison, plus rape and sexual assault makes the younger, weaker and disabled men very vulnerable. There is actually a law passed during the Bush years that addresses the seriousness of rape and assault in prisons. However, counting noses for sexual assault will not provide treatment for a disease that can now be controlled with anti-retroviral drugs.

Today I was reading about a program for HIV screening of male inmates in the state of Washington, 2006-2010. When the program was opt-in (inmates offered the test during incoming medical evaluation and they needed to agree to it), there were fewer diagnoses of HIV than when prisoners were offered opt-out (during evaluation they were told the testing was standard but they could refuse it). Opting out brought in about double the new diagnoses. The numbers of new diagnoses using either opt-in or opt-out was not huge--but what baffles me is why they were given a choice, since in other STDs, testing seems to be a part of the screening without prisoner choice. Also, these are NEW diagnoses--some carriers were already know to the health authorities since they were not new to the system.

Since a higher proporation of prison inmates are minorities, and a higher proportion of minority men have HIV/AIDS, this option to be tested has a greater impact on the minority population in general, since most of the incarcerated will evenually leave prison and go home to their families--untreated and undiagnosed, and probably not reporting they were assaulted in prison.

Of those diagnosed with new cases (not the total group), 42% who had newly diagnosed HIV identified themselves as heterosexual and 21% reported sex with men, and 32% reported IV drug use. Many young people today do not remember the severity of the AIDS epidemic in the 1980s before the new drug treatments--and combine that with the generally lack of foresight among the young, and I believe you have a toxic brew that could be made less dangerous if the prison systems required HIV testing with no opt-in, opt-out, or crying about violation of rights by some do-gooders who can't look beyond next year to see what will happen down the road.

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