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MD urges universal testing for HIV

Patients could opt out of screening, but doctor argues it could help uncover up to 16,000 cases

January 06, 2007

Michele Henry

Making HIV testing a routine part of any doctor's visit is at the heart of a debate in Canada's medical community, which is desperate to reduce the number of people who are infected with the virus but don't know it.

With "universal testing" patients would have to opt out of being screened for HIV during a physical or regular blood work. Taking a detailed sexual history, doing a risk assessment and conducting pre and post-test counselling would no longer be mandatory.

In Canada roughly 58,000 people are HIV-positive. According to the Canadian Public Health Agency 16,000, or 26 per cent, don't know they carry the virus.

Dr. Kelly MacDonald, director of the HIV research program at the University of Toronto, said a significant proportion of new infections result from people not knowing their "exposure status."

She said the debate hinges on a single point. "It becomes an issue of weighing people's rights to privacy versus their rights and obligations to society," she said. "If you have your privacy but have HIV and die from it, your privacy has done you no good."

The issue of whether to implement universal testing in this country was a hot topic in September when U.S. health authorities recommended all Americans between 13 and 64 be tested when they go for a check up.

It was brought back into the spotlight this week after Toronto physician Brian Cornelson called for such widespread testing during the sentencing hearing of Vincent Walkem, who infected two women without telling them that he was HIV-positive.

Current practice for HIV screening in Ontario involves taking a detailed risk assessment and sexual history from the patient, getting verbal consent and conducting pre- and post-test counselling.

MacDonald said the practice is cumbersome. It is also problematic in that patients have to initiate the process by requesting the test.

MacDonald said people don't ask to be tested often enough thinking they aren't at risk. They may not disclose important details of their sexual history. Some don't seek testing believing, in error, blood work they've had in the past would reveal if in fact they carry the virus. Others think testing isn't necessary unless a doctor suggests it, MacDonald said.

Since a positive result is no longer tantamount to a death sentence, MacDonald said testing speeds up treatment and reduces transmission of the virus to others. She said making HIV testing as common as screening for high cholesterol will help reduce the stigma attached to AIDS.

But, Dr. Philip Berger, an HIV expert, said without mandatory counselling people may not be aware that physicians are required to report positive results and infected individuals to the Canadian Public Health Agency. Patients may not know they can be tested anonymously at a clinic.

Since HIV testing for pregnant women became universal a few years ago, the number of HIV positive prenatal women has doubled, Cornelson said.

Toronto Star
"Reproduced with permission - Torstar Syndication Services"

Toronto Star




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