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Too Few Americans Get HIV Test Early Enough

June 26, 2009

Too many Americans with HIV are diagnosed late in the course of their disease and miss out on the optimal benefit of effective treatments, U.S. health officials reported Thursday.

As many as 1 million Americans are infected with HIV, but approximately 20 percent don't know they have the disease because they haven't been tested for it, according to the U.S. Centers for Disease Control and Prevention. That's why the agency recommends that HIV testing be a routine part of any medical examination.

"People are learning about their HIV infection several years after being infected," explained lead researcher Dr. R. Luke Shouse, from the CDC's Division of HIV/AIDS Prevention in the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.

"This means that they may have unknowingly transmitted HIV," Shouse said. "It also means that there is a time when they had HIV when they were not under appropriate medical care, so there are missed opportunities for prevention and care."

The new report on HIV testing appears in the June 26 issue of the CDC's Morbidity and Mortality Weekly Report, to coincide with National HIV Testing Day on June 27. The day promotes testing as an important strategy to prevent and control transmission of HIV in the United States, according to the CDC.

According to the report, which collected data on people diagnosed with HIV/AIDS in 34 states from 1996 to 2005, 38.3 percent of those diagnosed with HIV were diagnosed with AIDS within a year, and 6.7 percent were diagnosed with AIDS over the next two years.

Since progression from HIV to AIDS typically takes about 10 years without treatment, these findings highlight the importance of testing for HIV early, when antiretroviral treatments can deliver maximum benefit, Shouse said.

Minorities were more likely to be diagnosed late, compared with whites, and more minorities than whites progressed to AIDS within three years, the researchers found.

In addition, people whose initial HIV diagnosis occurred when they were older were more likely to progress to AIDS within three years. Men diagnosed with HIV were also more likely to develop AIDS within three years, the researchers noted.

"It's important to be tested for HIV -- routine screening for folks 13 years and above with regular medical visits, and at-risk populations should be screened annually," Shouse said.

Another report in the same issue of the CDC journal showed that too few high school students have been tested for HIV. In fact, only 12.9 percent of all students, and 22.3 percent of students who have had sex, have been tested, researchers found.

"When you look at the younger age groups, we estimate, a little under half of people 13 to 24 who are HIV-positive know they are infected," said lead researcher Andrew C. Voetsch, also from CDC's Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

Voetsch said that to get more people tested, the message has to be reinforced with health-care providers, so public health agencies must educate health-care providers on the importance of testing. Also, people need to be educated about identifying HIV early, to get them into treatment and make them aware of how to protect their partners, he said.

A. David Paltiel, professor and acting division head of the Division of Health Policy and Administration at Yale University School of Medicine, said late testing is a problem that has been around for a long time.

"All of those people who are tested late have been unable to access drugs that would prolong their life," Paltiel said. "They are at much higher risk of the complications that actually kill people. This means a lot of mortality that could have been prevented."

Paltiel agreed that HIV testing should be a routine screening procedure. "There should be routine HIV testing for all sexually active adults and teenagers in all health-care settings," he said.

Routine HIV testing has been opposed because it stigmatizes people, Paltiel said.

"But now we've got these magnificent drugs that really do save lives, that really can reduce the transmission," he said. "So to the extent you make HIV screening routine, without singling people out, you may not only help save lives [and] reduce transmission, but you may destigmatize HIV testing."

Tags: HIV/AIDS Prevention, Viral Hepatitis, TB Prevention, A. David Paltiel

More HIV cases confirmed in adult film performers

June 19, 2009

At least 16 additional unpublicized cases of HIV have been confirmed in adult film performers following a porn actress' recent positive HIV test, it was reported on Friday.

The newly released data by the Los Angeles Department of Public Health brought the number of HIV cases in porn performers in the last five years to 22, including the case disclosed this week, according to the Los Angeles Times.

The confirmation came despite the porn industry assurances that the film actress was the first HIV-infected case since a 2004 outbreak shut down production for a month, the paper said.

The disclosure is bringing renewed scrutiny to the estimated US$12-billion-a-year industry's long history of resisting regulation and condom use, the paper noted.

The Adult Industry Medical (AIM) Healthcare, which tests porn performers for sexually transmitted diseases, has been stonewalling the true picture behind the porn industry, said the report.

"AIM Healthcare has never been cooperative with us and our investigations," said Dean Fryer, a spokesman for the state Division of Occupational Safety and Health. So far, the clinic has declined to tell county or state officials the name of the performer or her employer.

"You'd think they'd want to be a full partner in trying to prevent the spread of this disease," said Dr. Jonathan Fielding, health officer for Los Angeles County.

The female performer first tested positive on June 4, said Dr. Colin Hamblin, AIM's medical director. She worked the following day -- June 5 -- for reasons Hamblin said are still being investigated. A second positive result came back on June 6. And the clinic is awaiting results of a third and final confirmatory test, he said.

The actress had two recent sexual partners, according to AIM. One is a porn actor, now under work quarantine, who performed with the woman on June 5. The other is her boyfriend. Those men have had sexual intercourse with an additional six people, who have all been notified and offered testing, Hamblin said in remarks published by the paper.

So far, no one known to have had contact with the woman or her partners has tested positive for HIV, Hamblin said.

He said the clinic is following all reporting rules, but because of patient privacy concerns cannot legally disclose the patient's name or employer to the county. "They also have to realize we have limitations too," Hamblin said. "We'd be happy to work with the county in any other capacity."

Attorney Kim Martin, special counsel to the state health and worker safety agency, said that the state health department and other public health agencies are exempt from those privacy laws and that they will continue seeking cooperation from the clinic.

In a statement published on AIM's website, Sharon Mitchell, the clinic's co-founder and a former porn star who appeared in more than 2,000 films, said the media was "like a moth to a flame."

"Rumor is rampant when the words 'HIV' and 'porn' are in the same sentence," she said.

Mitchell said AIM's clinic has been a leader in promoting prevention and testing. But, she added, "we are not the police department of the industry nor wish to be."

Tags: HIV/AIDS Prevention, Viral Hepatitis, TB Prevention, A. David Paltiel


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