HIV is LIKELY to go undetected or misdiagnosed – So how?

Have you ever been tested for HIV when you went to see your GP for a cold or flu?

 

My bet is No, even though the typical, early symptoms of HIV are almost EXACTLY the same as a bad cold/flu –  high fever, aching joints, swollen lymph nodes, bad cough etc.

 

So think about it. If you were never tested for HIV when you went to see your doctor for a flu, what makes you think that HIV infected people will be correctly diagnosed at that early stage? Wouldn’t they be misdiagnosed for a flu?

 

That’s exactly what happens.

 

“In 2006, more than half (58%) of the new cases already had late-stage HIV infection when they were diagnosed. This was similar to the pattern in previous years……

Most of the new cases in 2006 (78%) had their HIV detected when they had HIV testing in the course of some form of medical care. A much smaller proportion were detected as a result of voluntary HIV screening (13%). The rest were detected through contact tracing and other screening. When differentiated by sexual orientation, a higher proportion of homosexuals had their HIV infection detected via voluntary screening compared to heterosexuals (35% vs 3%).”

– http://www.moh.gov.sg/mohcorp/currentissues.aspx?id=16114

 

Which really means that, whenever you decide to engage in sex with anyone, the best thing you can do for yourself  is to assume that the person is HIV positive, and use a condom — which is 99% effective if you use it CORRECTLY, and 100% of the time.

 

 

In the meantime, these statistics provide a very good argument for automatic, opt-out testing. The government initiative to test all male patients coming into Singapore’s public hospitals, regardless of the illness they came in for, can address this very high rate of misdiagnosis. The number of undiagnosed HIV cases are thought to be about 2x the numbe of diagnosed cases.  The idea of automatic testing is not to ostrocise or to “doom” these HIV victims — the idea is to reduce the spread with early detection, and to get treatment to prolong life.

 

Why is it only restricted to men? Because HIV tests have an inherrant error rate (that’s just the technology limitation), and the HIV infection rates for women are still low enough that it is hard to distiguish the error rate from the real positives, so it is not that helpful as a screening measure for women.

 

While from a public health perspective, automatic HIV testing is an effective detection measure, the social consequence would be the increased stigma attached to being HIV positive.  This is something we cannot ignore, because HIV infected people have a right to be treated with dignity — and that includes the right to keeping their status confidential, their right to treatment, their right to doing all activities that would not result in the further spread of HIV.

 

Moving forward from Obama’s “We reject as false the choice between our safety and our ideals”, we need to make sure we have strategies that both enhance our health safety as a population, and safeguard the rights of HIV infected people, which they fully deserve. This is fully possible if we want to achieve it, and we have to consciously reject as false any assertion that we have to choose between our public health and human rights.

 

So auto-testing would enhance our health safety as a population, and enable the HIV patients to start treatment early to prolong their life and enhance their quality of life. I think Singapore got that right

 

It’s the second part that we need to make sure is in place — and recognise that achieving our ideals of according HIV patients the rights they deserve, need not compromise our health safety at all.

 

What needs to be in place ? This is a non-exhaustive list which would be nice if readers could add on to.

 

The State’s to-do list:

 

1. Affordable treatment .

Affordable not only in the sense that the patients can pay for it, but affordable in the sense that after paying for the treatment, they can still afford to have a normal life — to still be able to pay for their utilities, mortgages, children’s education , even a holiday or two. They should not be enslaved by the cost

 

2. Accessible treatment of high quality

Treatment that is accessible and affordable should not just be the basic, Third-world, scrapping by type of treatment. In should be in line with the country’s philosophy of having First-world, world-class, health care.

 

3. Enforced, laws (not guidelines) preventing discrimination at the workplace

HIV CANNOT spread through working together (unless you’re in the unprotected-sex trade/ having unprotected sex with your colleagues). In the same way that the government took concrete action against the discrimination of pregnant women, similar action has to be taken against workplace discrimination.

 

4. Laws protecting confidentiality

Patients have the right to confidentiality. When this confidentiality is breached, patients should be able to sue the violating parties. In bringing on these lawsuits, patients should have provisions to protect their confidentiality during the legal proceedings, similar to how rape victims are protected during legal proceedings

 

5. Laws protecting against discrimination

Patients should be able to sue organisations that practice discrimination, similar to the way we can, if we are discriminated based on race / religion etc unnecessarily. This is slightly different from workplace discrimination –which has to be enforced more strongly because it is their means of livelihood. Here, we want to enforced their rights to be treated without discrimination by country clubs, associations, schools,  media portrayals etc

 

6. Family members of HIV patients have to be protected under the same laws, as those above.

 

7.  Have a long-term public education programme against discrimination against people living with HIV

Public education should go beyond stopping the spread of HIV, but should to decrease discrimination amongst those affected. In campaigns for safer sex, other groups of people should not be discriminated against, eg. homosexuals , women (notice how ads always portray women as the agents of infection? women are forced into either categories of being a slut or being a virtuous wife — another false dichotomy). Governmet bodies need not be the ones running these programmes ; they can provide funding to diverse groups who can conduct these campaigns from all the different perspectives

 

 

 

We, the Peoples, to-do list

 

1. Make friends with people with HIV — we will then learn that they are as human, as good, and as bad as we are

 

2. Learn more about what living with HIV is like

 

3. Speak up whenever discriminatory words/acts are observed

 

4. If you are in the position of power eg. as a policy maker, as a HR manager, as a journalist — exercise your power responsibily

 

5. Spread the message