Forty Percent of HIV-Positive Individuals Receive HIV Test Only After Developing Symptoms, CDC Reports
Two separate studies presented yesterday at the National HIV Prevention Conference in Atlanta found that nearly two out of every five people with HIV live with the disease for nearly a decade before being tested, "forgoing life-prolonging treatment and potentially infecting others," the Atlanta Journal-Constitution reports. In the first study, the CDC surveyed 19,000 AIDS patients in 12 states between 1990 and 1999 and found that 40% learned of their HIV status in the 12 months prior to being diagnosed with AIDS (McKenna, Atlanta Journal-Constitution, 8/15). A patient can receive an AIDS diagnosis when his T-cell count falls below 200 or when he develops an AIDS-defining opportunistic infection listed in the CDC's AIDS case definition (Auge, Denver Post, 8/15). In the second study, researchers with Kaiser Permanente examined the medical records of 434 HIV-positive patients and found that 40% "displayed symptoms of infection or told health care providers of risky behavior" more than a year before being diagnosed with HIV. Because it usually takes up to a decade for HIV to progress to an AIDS diagnosis, the findings are significant because many infected people unaware of their status are not receiving treatment and possibly infecting others. "We must reach these individuals at an earlier stage of infection for their own health and to prevent transmission to others," Dr. Ron Valdiserri, deputy director of the CDC's HIV prevention programs, said (Atlanta Journal-Constitution, 8/15).
Why the Delay?
According to HIV prevention groups, people are avoiding HIV testing because they are "afraid of the results" or they do not think they are at risk. "There are still large pockets in our society that don't know that AIDS is not a death sentence. And even for some folks who know that, they don't have the medical access to know that there's something to do about it," Phill Wilson, executive director of the African American AIDS Policy and Training Institute, said (Ornstein, Los Angeles Times, 8/15). The CDC survey found that 46% of Latino and black men were inclined to delay testing compared to 32% of white men, while 44% of Latina women and 42% of black women tested late compared to 36% of white women. Among risk groups, 39% of gay men delayed testing, and 40% of intravenous drug users tested late. Fifty-one percent of people who became infected through heterosexual contact delayed testing. The Kaiser Permanente survey and a separate Seattle survey of 300 gay men, which found that 36% received repeat HIV counseling from their physicians over a three-year period, demonstrated that late testing is not solely due to a lack of access to health care. "These data show that even among persons with reasonable access to quality health care, HIV may go undetected for several years. People in general aren't comfortable talking about HIV. ... We don't like admitting to ourselves that we're at risk," Leo Hurley, a Kaiser Permanente epidemiologist, said, adding that the stigma associated with HIV testing is "enormous and needs to be addressed" (Brown, Washington Post, 8/15). Deanna Merrill, Kaiser Permanente's national coordinator for HIV/AIDS research, said that health providers "need to make sure we stress that people need to be honest with themselves when assessing their own risks and communicating their concerns" with their physicians (Denver Post, 8/15).
Getting More People Tested
The news that many people delay testing until they are noticeably sick is "troubling" because it "come[s] amid signs that AIDS is making gains again," Valdiserri said. Recent studies have indicated that "risky sexual behavior" is on the rise among gay and bisexual men and low-income black women (Simao, Reuters/Philadelphia Inquirer, 8/15). "Clearly these findings point to a need for new approaches and strengthened commitments to HIV prevention," Valdiserri added (Hitt, Reuters Health, 8/14). The CDC recently announced plans for new awareness and testing initiatives aimed at halving the number of new HIV infections by 2005. To support that goal, officials said they are considering sending "mobile HIV testing" units to homeless shelters, gay bars and "other areas frequented by those engaging in high-risk sex" (Reuters/Philadelphia Inquirer, 8/15). Kaiser Permanente has issued new guidelines for its physicians to aid them in identifying patients who should be tested. Kaiser has also "streamlined" the testing and notification procedures for its HMO clients (Los Angeles Times, 8/15).
Evertz Under Fire
Scott Evertz, director of the White House Office of National AIDS Policy, addressed an "openly skeptical audience" at the conference yesterday in his first public address since taking office four months ago, Newsday reports. Evertz, who was appointed in April after the White House drew criticism for apparent plans to close the office, defended the administration and his low profile so far. "My presence [here] really is the best way to convey to you that the Bush administration really does care about AIDS. ... It's hard in times of urgency to ask for patience, but I ask you to be patient," Evertz, who said he has spent the last few months "on a steep learning curve," told the audience of 3,000 government and private sector health workers. His appointment "drew heat" from both conservatives, who were upset that he is openly gay, and liberals, who decried him as an "antiabortion Christian activist." While being "repeatedly interrupted," Evertz also addressed "rumors" that the administration had "muzzled" him, saying he has "never been told what I can and cannot say." His role as national "AIDS czar" is to "buil[d] bridges between the White House and community groups working on AIDS issues" and to "facilitat[e] communication" between those groups and government agencies, he added. When asked about the "doubling" of funds for abstinence-only education, Evertz said he was not aware of how the funds were being spent, but added that "a lot" of HIV prevention strategies are based on abstinence "at the beginning until they prove themselves" (Garrett, Newsday, 8/15).
Other Findings at the National HIV Prevention Conference
Several other studies were released yesterday at the conference. Summaries of those studies appear below:
- A study by researchers at the University of California-San Francisco has determined that the probability of contracting HIV through "unprotected receptive oral sex with a man" is practically null. The study followed 198 gay and bisexual people in the San Francisco area, 98% of them male, and found that of the 20% that reported receptive oral sex with an HIV-positive partner, only one infection was known to occur and that infection was not recent and "could not be attributed to the period of exclusive oral receptive intercourse" (UCSF release, 8/14). Speaking yesterday on NPR's "All Things Considered," Kimberly Page Shafer, the lead author of the study, said, "The most important thing we found out is that none of the people that we've been studying or have studied have gotten HIV. Our results suggest that oral sex is safer sex." Although prior research on the risk of contracting HIV through oral sex had "dramatically different findings," Valdiserri said, "We know it's possible to transmit HIV through oral sex, but it is not a common event. The concern is, however, that even with a low-risk sexual practice, if it is practiced with many different partners over a long period of time, that risk can increase. So we want to stress that low risk is not the same as no risk." The full report in RealAudio is available online (Wilson, "All Things Considered," NPR, 8/14).
- Officials from the Walter Reed Army Institute of Research yesterday presented findings that found the InstantScreen (R), a rapid HIV test kit, manufactured by BICO, Inc., is 100% accurate. The test showed "100% sensitivity and 100% specificity" during the 600 tests performed by Walter Reed researchers (BICO release, 8/14).
- HIV/AIDS "cannot be stopped without the help of black churches" in the South, according to researcher Emily Moore, the Augusta Chronicle reports. Moore, with funding from Iowa State University, spent three years examining how "the beliefs of rural religious leaders affect a community's attitudes and opinions about HIV and AIDS" and found that most black religious leaders in the rural South "refuse to discuss AIDS from the pulpit," thinking that their parishioners are "immune" to the disease and have "no need to hear about it" in church. That attitude, combined with "homophobia and a lack of health education, have contributed to a culture of intolerance and denial toward AIDS in many black churches," Moore said (Basinger, Augusta Chronicle, 8/15).