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This post was published on 20/09/08 in Money and AIDS.

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  1. Pingback by peripheries » Blog Archive » BHIVA’s guidelines for HIV testing: Who, When & Why?, 20/09/08, 05:30:

    […] at the Wisdom of Whores, thought the guidelines “are very nearly extremely sensible. But…” was making “very little […]

  2. Comment by Roger, 20/09/08, 05:32:

    When there is no guarantee that vulnerability is limited only to a group of people and when treatment can be offered to all, there is no reason to offer testing and treatment on a priority or at-risk basis. To do so would be unethical.

    You know where to read more !

  3. Comment by Alasdair King, 20/09/08, 06:39:

    There are two very good reasons to offer testing on a priority or at-risk basis:

    First, testing people who are unlikely to be affected causes unnecessary distress and pain.

    Second, it means wasting finite money. I want my UK tax money to buy the best health service available, based on clinical need, which means prioritising testing to at-risk groups. Or would you advocate my going for breast cancer screening for my 34-year-old male chest?

  4. Comment by Roger, 22/09/08, 02:04:

    Hi Alasdair,

    Your first opposition is about distress and pain.I would not consider an HIV Test as painful. Distres is another issues very much contextual. It is stressfull because we have made it so. If you are HIV positive you will have to deal with stress. You can put your head in the sand, continue to infect other “inconsciously” but one day it will catch up. Your life expectancy will then be much shorter and you will know what distress is.

    Your second is about cost and how tax payer money should be used. Let’s give GPs and people a minimum of credit and brain but the question here is do we want a US-style NHS or a UK/French style NHS? Then how much money will be saved by not having to treat HIV once the epidemic is over?

    I’d refer you to this below published in last week science. Keep in mind that more than 25 billion has already been invested with a rather poor outcome mostly because dogma and political agendas dictated a response that science and common sense should have been leading (see Elizabeth’s book about this). Time to get ride of the blindfold.

    HIV Testing for Whole Populations

    The Policy Forum “Reassessing HIV prevention” (M. Potts et al., 9 May, p. 749) summarizes current approaches to control of HIV infections. Although these strategies have shown some reduction in prevalence of HIV infections, they are not fully effective. Clearly, new approaches should be considered.

    One approach, first proposed by Montaner et al. (1), would be to test entire populations for HIV infection using polymerase chain reaction (PCR) and then to treat all positives with antiretroviral therapy (HAART). This may be effective, given that patients with the low viral loads achievable by HAART treatment are generally not infectious by sexual routes (2-4) or by maternal transmission to newborns (5, 6).

    This approach would be expensive. We estimate that application to all 17 sub-Saharan countries with HIV prevalence of >5% would cost an average of about $20 billion per year, assuming that screening of populations would take place every 5 years. This is a very high figure, but it is affordable by the major donor nations and would likely have substantial health benefits.

    The approach would face other challenges as well. Extensive training of laboratory and field personnel would be required. Fear of the stigma involved in HIV positivity would have to be addressed by widespread publicity stressing the advantages of HAART for those infected, and for those not yet infected, in the populations screened. This has been effective in Brazil, where 170,000 infected people are already being treated with HAART. This has resulted in stable HIV prevalence (0.6%) since the initiation of widespread screening and treatment in 2000 (7).

    Such a bold plan would require controlled studies to assure its efficacy, but the benefits would likely outweigh the costs.

    Alfred M. Prince

  5. Comment by A, 03/10/08, 04:58:

    Hello All,

    I’ve recently read your book and have you to thank for really opening my eyes to the situation in the world. I’m currently in college and am writing a paper on a topic in regards to AIDS. From all that I read and what I’ve experienced in my personal life, personally rubbing elbows with whores of all sexes :). The idea that many are out there not knowing what their status is and spreading to the unknowing populace is a frightening thought.

    I’ve decided to write my paper on a proposed plan to institute mandatory testing (in the US). I understand this is not a popular option, but it seems that the current programs are just not going far enough, and there are many people, that I have run across in my studies that are not positive that the numbers we have on HIV/AIDS infections in the US are even close to being accurate.

    NOTE: I don’t support quarantine of infected persons. My idea is that by making a generalized form of testing for the entire population, say every year, to keep a driver’s license active, or to get your tax refund or something… just to take the test, that’s all.

    I’d like to hear some thoughts on this topic.

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