Thursday, October 08, 2009
This, in a nutshell, is the challenge we face. Rather than a community-based approach to stopping the spread of HIV, we have an institutional-based approach, and it is an institutional model that, despite pledges otherwise, are very much driven by the "high-risk/stigmatized" approach that stubbornly refuses to take a broad-vision approach to HIV-testing.
I have recently joined a panel (called together by the National Institutes of Health) to develop a new "TNT" (Test and Treat) protocol for two urban areas. As with so much of what I have seen, it is a very passionate and intelligent group of people (we have not actually met face-to-face - that will happen next week). They have wisdom and experience in HIV-work. One of the charges is to expand testing. What I struggle with is this: they seem to have a huge blindspot about HIV-testing that limit the possibilities. The only vision they have about testing is how to get people into their systems. The only expansion of testing that they are talking about is including HIV-testing in hospital emergency rooms. Can you imagine going into an ER with a broken knee and somehow being expected to process with informed consent that you will be tested for HIV? Given that one of the main objections to community-wide testing is the concern for counseling, I can't imagine an ER being the kind of situation where people coming in for one condition being confronted with an HIV-test fits. One of the basics of counseling is to meet the client where he/she is at. HIV-testing in ER's for all people hardly fits, unless it is truly part of a "we are all doing it" approach.
The current HIV-testing system has its roots in a time when only people deemed at-risk were tested, the stigma was worse than now, the testing process called for a blood draw that was sent to a lab, and there were really no viable treatments available. Pretty much all of this has changed, but the institutional rigidity remains. Perhaps it is really time to call for a dismantling of the current testing system, start from scratch in a way that cheaply and efficiently makes testing available for all people, and put most of the resources into treatment. That would be my suggestion.