Friday, March 23, 2007
Why the cynicism? Because I fear we are at a serious crossroads, and after two months of seeing divided services, apathetic responses, denial that testing matters, and yet heartfelt statements that people really do want to make a difference (while continuing to not do the one thing we all can do), I am more convinced that our institutional approaches are as much a part of the problem as they are in providing the solution, if not more so. In addition to these professional experiences, I have had a couple of personal blows (currently being uninsured, although that will change), and perilous financial situation that was triggered as much by my former employer not paying off a $100 visa bill from when I worked there, and this account going into 90 day late cycle adversely affecting all of my interest rates to the point that I can no longer keep up (and all this by a corporation that has made not one but THREE commmitments to people with AIDS apparently as long as they can keep them at arms length). So I find myself being increasingly skeptical that the institutional approach to slicing and dicing the population beyond recognition and beneath humanity is going to accopmplish much of anything.
I recently asked the coordinator of the clinic in one of our neighboring towns how that clinic is implementing the new CDC guidelines that are encouraging MD's to offer HIV tests to all people. The reply: "We first identify who we thingk needs to be tested, and then we refer them to our partner clinic (about 15 miles away). What part of this suggests that all patients are being encouraged to be tested? And, with transportation challenges, and the fact that testing requires two visits, how feasible is this?
This is a mild example of the institutional approach. And the thing is, this May is the one year anniversary of the CDC announcing its intention to shift focus for testing. But many local and regional HIV-testing organizations are awaiting further instruction on how to implement this (what part of "all people" is so hard to understand?).
So here's my proposal: all people go get tested. Let's rally the troops and make a regional and statewide commitment to get everyone tested, including ourselves. For each person who is living with HIV who is undiagnosed, there are countless more at-risk every day. And yet, every day presents an opportunity to shift direction. And with each test, we move closer to the truth while having an opportunity to educate about HIV, about compassion, and about making a difference. The worst feeling we could have is to see HIV rise in Illinois from 40,000 to 60,000 and beyond (especially since the funds for treatment are decreasing). We've been down that road before; it's not pretty, and the toll on finances and human lives is too costly.
Labels: HIV and the Undiagnosed
Monday, March 12, 2007
While initially to response seemed luke-warmly positive, one question that seemed to be lingering was: since DuPage County has such a low disagnosis rate (average of 30 per year), how much effort should the health department put into this effort? (See: http://www.suburbanchicagonews.com/napervillesun/news/285723,6_1_NA07_HIV_S1.article
A couple of thoughts about this:
- With an undiagnosed rate of between 30 and 50%, we know that there are more people out there. In Illinois, it is estimated that thereare 10,000 people undiagnosed. Each one has the potential to easily give the virus to someone else, which could bring this number to 20,000. If that process replicates one more cycle, we are all of a sudden at 40,000 cases (30,000 new infections plus the 10,000 undiagnosed). This is not to say that this will happen, but it certainly is in the realm of possibility. Most importantly, if we can promote global testing (and it has been demonstrated that this is more effectively done when community leaders get tested and promote it), we will certainly move closer to getting these undiagnosed folks in for testing.
- A few years ago, Senator Durbin commented to me that the government could not afford to promote universal testing. I don't think we can afford not to, given the high cost of treatment. In fact, the Centers for Disease Control is now encouraging all people to get tested.
- Even at an average of "only" 30 new cases per year, that's 30 families. And this also doesn't count the families of people who live out of DuPage County. And, with treatment costs of $20,000 per year, do the math. And, if you are one of the 30 (or families of those 30), or someone with HIV, or lost someone to AIDS, think how hurtful it is to know that your elected officials look at your life and pain as a statistic.
- Finally, when everyone gets an HIV test, it moves us all closer to the truth about our community. In the ethical analysis, doing this does no harm, and there is a community benefit. It is rare when the benefits so clearly outweigh the costs.
We certainly have our work cut out for us, but as Queen Latifah, fellow Rutgers grad, says in her new HBO film in which she plays an HIV/AIDS activist, "We will keep talking about this as long as people keep getting HIV".