AIDS tests without fear
IT TOOK a quarter-century of sustained medical attention, but AIDS is no longer an automatic death sentence, at least in the United States. Millions of infected people are living with AIDS, not dying from it, thanks to improvements in drug therapies known as anti retrovirals. Shockingly, though, the Centers for Disease Control and Prevention estimates that 250,000 Americans are infected with HIV, the virus that causes AIDS, but don't know it. AIDS testing ought to be routine.
A person who is ignorant of his HIV status not only will miss out on early access to treatment, but risks infecting others. So the recommendation last month from the CDC that HIV tests become routine for all teenagers and most adults is both sound and overdue.
Some oppose universal testing because of the stigma that still attends the disease. The concern is real: In much of the developing world people can lose their homes and children, or suffer physical violence, if they are found to be infected. Many truly would rather die than know their HIV status. But the advent of life saving drugs in 1996 changed that calculus dramatically, and the CDC testing proposal is explicitly voluntary: patients can opt out at any time.
The value of regular testing assumes that the drug therapies be widely available, however, and this is not true in too many parts of the country. According to research by Drs. Kenneth Freedberg and Rochelle P. Walensky of Massachusetts General Hospital, among others, 23 states lack sufficient funding to make the anti retrovirals universally available to poor and uninsured patients. These states -- Alabama, Kentucky, Nebraska, and Arkansas, to name a few -- suffer from a patchwork system of state AIDS Drug Assistance Programs (ADAPs) funded through the federal Ryan White act.
The ADAPs vary widely state-to-state in their funding levels and eligibility requirements. Some have tightened eligibility to respond to budget cuts. Some have waiting lists. Some have anti retrovirals but not sufficient drugs to treat HIV-related infections such as pneumonia. Further research suggests that these disparities may lead to survival differences of up to four years, based solely on where a patient lives.
``We've made it difficult for people to access drugs that we know are lifesaving and cost-effective," Freedberg said. One answer is a national formulary of essential AIDS drugs that would equalize availability and funding, but that is slow in coming.
Universal testing for AIDS is a development whose time has come. But it must be matched by universal counseling and treatment for those who test positive for the disease. Only then will the circle of AIDS prevention and care be unbroken.
