Physician: HIV Test Guidelines not being Followed. 5/10/10

"Physicians still haven't given up the old 'I can tell by looking,' risk-based" testing

The Wichita Eagle

Wichita physician Donna Sweet says neither patients nor physicians are following HIV screening guidelines unveiled four years ago by the federal Centers for Disease Control and Prevention.

In 2006, she said, the CDC recommended "with very good reasoning" that every sexually active American, age 13 and older, be tested for HIV.

"That was four years ago. It is one of the most widely undone (tests) and disregarded guidelines in medicine," she said. "Physicians still haven't given up the old 'I can tell by looking,' risk-based" testing.

The case of an Air Force sergeant accused of having unprotected sex without disclosing his HIV-positive status "points out that people have forgotten about this disease," she said.

Sweet, an internal medicine practitioner and professor at the University of Kansas School of Medicine-Wichita, has a large patient base of people who are infected with HIV or have AIDS.

An estimated 1.1 million people in the United States are HIV-positive and about 250,000 of them don't know they are infected, she said.

"They're not going to be able to say to you, 'Hey, let's use a condom because I could give you something.' It's back to the day of buyer beware."

Sweet said it's easy for a physician to offer an HIV test along with any other age- or risk-appropriate screening tests. An HIV test used to require a signed consent form, similar to the ones used for surgery, but no longer does.

If a patient declines the offer to be tested, that can be noted in his or her file.

But if a patient sees two or three doctors and never gets the offer for a test, then turns out to be infected, "It's just like a failed diagnosis for cancer, and you've got a lawsuit there," she said.

"It's really about the fact that this disease carries so much stigma and always has," she said.

Her practice normally gets about 100 to 110 new patients a year. "We're going to beat that record this year."

Early detection and treatment work, she said, and someone diagnosed at age 20 can expect to live to about 70 "if they take care of themselves and do things right."

Sandra Springer, HIV and AIDS director for the Kansas Department of Health and Environment, said people who are high risk for HIV and other STDs should get tested every three to six months.

Because people are living with HIV and AIDS and not seeing the devastating effects that were common early in the disease, "there are a fair amount of folks that have kind of a prevention burnout. It's not as on the forefront of people's minds as it was."

But knowing your status and being treated is important to the health of a community, Springer said, because "if someone is in care, they are less likely to transmit the disease to their partner because of their decreased viral load. It's still possible but not as likely if on treatment."

In addition, after people find out they're infected, "they do tend to change behavior," Sweet said. Medications can lower the presence of the virus to an undetectable level in the blood, at which point "they're much less likely to infect anyone," Sweet said.