Other Factors Influencing Hiv Transmission Risk
Within each route of transmission, estimates of the risk of transmission vary widely, likely due to the role of behavioural and biological co-factors. Viral load appears to be an important predictor of transmission, regardless of route of transmission. However, the evidence indicates that viral load is not the only determinant, and other co-factors, such as the presence of co-infections, play a role in increasing or decreasing the risk of transmission.
The strongest predictor of sexual transmission of HIV is plasma viral load . A dose-response relationship has been observed, where each ten-fold increase in plasma VL resulted in an increased relative risk of transmission of 2.5 to 2.9 per sexual contact. The concentration of HIV in genital secretions also plays a major role in sexual transmission. While there is a strong correlation between HIV concentrations in plasma and in genital secretions, some studies have found genital tract HIV shedding in 20% to 30% of men and women without detectable plasma viral load. Much of what is known about the impact of viral load on the sexual transmission of HIV is derived from studies of heterosexual populations. Very little is known about the relationship between HIV viral load and rate of transmission through anal intercourse.
Aids Privacy & The Community: The Ethics Of Mandatory Aids Testing And Disclosure
AIDS is the new plague–a disease that is not only physically and psychologically debilitating, but culturally and socially devastating as well. Like the plague, AIDS has caused fear, prejudice, and even panic in society–in fact, the backers of a 1986 California initiative that would have allowed mandatory testing for HIV infection and quarantine of individuals testing positive went by the acronym PANIC .
Public health officials agree that it is in the interest of the public to test for the presence of antibodies to the AIDS virus that indicate HIV infection and to identify “seropositive” individuals , since most people probably will modify the behaviors that cause the spread of the disease if they know they are infected. There is also general agreement that it is in the interest of infected individuals to get tested, since early treatment with AZT has proven effective in slowing the progress of the disease.
But in the highly charged atmosphere that has quickly developed in response to the AIDS epidemic, there are serious ethical concerns about HIV testing–particularly about suggestions that mandatory testing be imposed and that the results be disclosed in order to protect the health of the public. To address these concerns, the Center for Applied Ethics held a symposium on February 3, 1990, supported in part by a grant from the California Council for the Humanities, a state program of the National Endowment for the Humanities.
Hiv Disclosure Policies And Procedures
If your HIV test is positive, the clinic or other testing site will report the results to your state health department. They do this so that public health officials can monitor whats happening with the HIV epidemic in your city and state.
Your state health department will then remove all of your personal information from your test results and send the information to the U.S. Centers for Disease Control and Prevention . CDC is the Federal agency responsible for tracking national public health trends. CDC does not share this information with anyone else, including insurance companies. For more information, see CDCs HIV Testing Basics: Privacy.
Many states and some cities have partner-notification lawsmeaning that, if you test positive for HIV, you may be legally obligated to tell your sex or needle-sharing partner. In some states, if you are HIV-positive and dont tell your partner, you can be charged with a crime. Some health departments require healthcare providers to report the name of your sex and needle-sharing partner if they know that informationeven if you refuse to report that information yourself.
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Accused Queens Mom Killer Allegedly Thought She Gave Him Hiv: Court Records
New York doctors would be able to test patients for HIV without their explicit consent under a measure that advocates say would boost detection rates but which opponents argue is invasive and doesnt confront the issue.
The bill, sponsored by state Sen. Brad Hoylman and awaiting review in the Senate Health Committee, would put the onus on patients to read signs in their doctors offices informing them that they could be tested.
Current law requires that testing be offered to anyone between ages 13 and 62, but proponents of Hoylmans bill say doctors often avoid asking that question due to its awkward nature and because of time crunches in packed hospital and clinic waiting rooms.
Ive known plenty of people who didnt get tested but wished they had, because they not only may have unknowingly passed the virus on, but their well-being suffered, too, said Hoylman. Its better to know your HIV status.
Although the plan is well-intentioned, its a shortsighted solution to a much more complicated problem, argued Dr. Jeffrey Birnbaum, of SUNY Downstate Medical Center. Theres no data to prove that removing consent will fix the problem.
Birnbaum said the existing law should be sufficient so long as doctors are willing to ask the tough questions.
Doctors are saying this is too time consuming, too much of an inconvenience … but theyll talk about smoking cigarettes, obesity, diet and hypertension, he said. These are issues that also take time.
Human Immunodeficiency Virus2 Diagnosis
The possibility of human immunodeficiency virus 2 infection should be entertained in patients with the following risk factors:
Illness characteristic of HIV infection despite negative HIV-1 test result
West African origin
Sex partners or needle-sharing partners of a person known to be infected with HIV-2 or who is not infected but is from an HIV-2endemic area
Children born to women with HIV-2 or who have risk factors for HIV-2 infection
Persons who have participated in a HIV-vaccine trial or have receive blood products or a nonsterile injection in HIV-2endemic areas
People with unusual HIV-1 Western blot indeterminate patterns
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Distinguishing Premarital Testing Policies
Health policies and their implementation in practice can take different forms, each of which may raise different ethical issues. Recent debates concerning routine HIV testing have made clear the importance of making conceptual distinctions between types of testing policies. Ambiguous use of terms such as routine testing, routine offers of testing, opt-in and opt-out testing, mandatory and compulsory testing have lead to confusion about the policies and practices to which they refer and their ethical significance.22 Therefore, some basic distinctions need to be made prior to a discussion of the ethics of premarital HIV testing.
Mandatory premarital testing refers to policies that make HIV testing a necessary condition for civil and/or religious marriage. Mandatory HIV testing in general is defined as the requirement for persons to be HIV tested in order for them to access some perceived benefit or good. Policies requiring HIV testing before immigration to certain countries, joining the military or gaining employment are all forms of mandatory testing. Since mandatory here refers to the relationship between HIV testing and marriage, it should be contrasted not with voluntary or compulsory testing policies but with the alternative of simply not having to be tested for HIV in order to get married. When a mandatory premarital testing policy is in effect, HIV testing is still a matter of choice, although choosing not to be tested means having to forego marriage.
Introduction And Guiding Principles
A request was made by the Federal/Provincial/Territorial Committee on AIDS for the Public Health Agency of Canada to develop guidelines on HIV testing that reflect the realities facing care providers and their clients, as well as advances in HIV testing policy and practice. To inform the development of this guide, the Agency commissioned a literature review and consultations with key stakeholders, including people living with HIV/AIDS and other affected populations, academics, nurses, physicians, professional associations, non-governmental organizations, policy-makers, community workers, and legal and ethical experts. As a result, the recommendations outlined in the guide are based on the most up-to-date evidence and expert opinion.
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The Case Of Goma Democratic Republic Of Congo
Goma lies on the northern shore of Lake Kivu in the eastern part of the Democratic Republic of Congo . Administratively, it is composed of two communes with a combined population of roughly half a million people. Although the region is known for its natural beauty, it is also marked by a history of armed conflict, invasion by neighboring countries, human rights abuses and poverty. The region also has a high HIV prevalence relative to the estimated national figures.32
The DR Congo has no national policy regarding mandatory premarital HIV testing. The Programme National de Lutte contre la SIDA , the national AIDS control program in the DR Congo, recommends the promotion of voluntary premarital testing33 and has permitted pilot voluntary premarital testing programs in the country, funded by Family Health International and run by local nongovernmental organizations Femme Plus and Amo-Congo.34 The Facultés Catholique de Kinshasa, one of the most influential academic institutions in the country, recommended that its Faculty of Canon Law reflect on the issue of premarital HIV testing during its 24th National Episcopal Conference in 2005. No final recommendations have been issued to date.
Types Of Hiv Testing Services
The majority of healthcare venues carry out “standard” HIV testing. This means a tube of blood is collected in the clinic, hospital or physician’s office and sent to the medical laboratory along with a requisition ordering an HIV test. Standard testing can be done in any type of setting . Test results are generally available within one week.
4.5.2 Point-of-Care or rapid testing
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Testing Recommendations And Requirements
The U.S. Centers for Disease Control and Prevention recommends everyone aged 13-64, receive at least one HIV test as a part of routine health care and more frequent testing, at least annually, for those at higher risk. Per the CDC, individuals who may benefit from at least annual screening include:
- sexually active gay or bisexual men
- individuals who have had sex with an HIV-positive partner
- individuals who have had more than one partner since their last HIV test
- those who have shared needles or works to inject drugs
- people who have exchanged sex for drugs or money
- individuals who have another sexually transmitted disease, hepatitis, or tuberculosis
- those who have had sex with someone who has participated in any of the above activities or with someone with an unknown sexual history
Certain factors are known to reduce the risk of HIV transmission including condom use, antiretroviral treatment leading to durable viral load suppression among those with HIV, and the use of pre-exposure prophylaxis among those at increased risk for HIV.Additionally, HIV testing is recommended for all pregnant women and for any newborn whose mothers HIV status is unknown. Treatment provided to pregnant HIV-positive people early in pregnancy can reduce the risk of transmitting HIV to 1% or less. HIV testing is also recommended for anyone who has been sexually assaulted.
CDC recommends that all HIV screening be voluntary, and opt-out vs. opt-in .
Importance Of Hiv Testing For Prevention Of Hiv Infection
People with HIV who know their status can get HIV treatment and remain healthy for many years. Studies show that the sooner people start HIV treatment after diagnosis, the more they benefit. HIV treatment reduces the amount of HIV in the blood , reduces HIV-related illness, and prevents transmission to others. People with HIV who take HIV treatment as prescribed and get and keep an undetectable viral load will not transmit HIV to their sex partners.
People who get tested and learn they dont have HIV can make decisions about sex, drug use, and health care that can help prevent prevent HIV. Taking HIV medicine called pre-exposure prophylaxis is highly effective for preventing HIV.
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Insurance Coverage Of Hiv Testing
Most insurers now broadly cover HIV testing, many without cost-sharing, in part due to a decision made by the United States Preventive Services Task Force , an independent panel that assess the net benefit of preventive services and assigns a subsequent letter grade . Under the ACA, any A or B graded preventive services must be provided by most insurers without cost-sharing in addition, traditional Medicaid programs, while not required to provide USPSTF top graded services, are incentivized to do so. In 2013, the USPSTF gave HIV screening an A rating for all adolescents and adults, ages 15 to 65. It also gave an A grade to HIV screening for pregnant women. Both of these recommendations were reaffirmed in 2019. The current insurance coverage landscape of HIV testing is as follows:
How Can Hiv Testing Help You
About 1 in 8 people in the United States who have HIV do not know they have it.The only way to know for sure whether you have HIV is to get tested.
Knowing your HIV status gives you powerful information to help you take steps to keep you and your partner healthy:
- If you test positive, you can take medicine to treat HIV. People with HIV who take HIV medicine as prescribed can live long and healthy lives. Theres also an important prevention benefit. If you take HIV medicine as prescribed and get and keep an undetectable viral load, you will not transmit HIV to an HIV-negative partner through sex.
- If you test negative, you have more prevention tools available today to prevent HIV than ever before.
- If you are pregnant, you should be tested for HIV so that you can begin treatment if you’re HIV-positive. If you have HIV and take HIV medicine as prescribed throughout your pregnancy and childbirth and give HIV medicine to your baby for 4 to 6 weeks after giving birth, your risk of transmitting HIV to your baby can be less than 1%. HIV medicine will protect your own health as well.
The sooner you know your status, the better. Some people with HIV have it for years before they know it. During that time, they arent getting the treatment they need to protect their health and prevent transmission of HIV to their sexual or needle sharing partners. Thats why CDC encourages more frequent HIV testing for individuals who might have a risk for getting HIV.
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Hiv Testing In Canada
Information about HIV testing patterns in the general population, along with information on the profile of people being tested, is important for designing and targeting intervention programs.Footnote 1 In 2006, a general population survey of 2,036 Canadians over the age of 15 showed that 32% of respondents had ever been tested for HIV, a slight increase from 27% in 2003.Footnote 2
Canadians who want to be tested for HIV have up to three different testing options, depending on the province or territory in which the testing takes place: nominal, non-nominal or anonymous. At present, nominal/name-based and non-nominal/non-identifying HIV testing are widely available in Canada however, anonymous HIV testing is available in only seven provinces.
Nominal/name-based HIV testing
- Footnote *
- *In rare instances, the true identity of the person being tested for HIV may not be known.
Non-nominal/non-identifying HIV testing
- Similar to nominal/name-based testing with one exception: the HIV test is ordered using a code or the initials of the person being tested .
Table 1 provides information on the availability of different types of testing as well as reporting protocols within each province/territory.
Oral Fluid And Urine Hiv Testing
An FDA-approved EIA known as OraQuick Advanced is available for the testing of human immunodeficiency virus -1 and HIV-2 in oral fluid and blood in non-clinical settings . In addition, there are the Avioq HIV-1 Microelisa System as well as the DPP HIV-1/2 Assay . While the DPP HIV-1/2 Assay can also be used to test whole blood, the Avioq HIV-1 Microelisa System can only be used with oral fluid and dried blood spots.
The main concern with the oral fluid test has been clusters of high rates of false-positive results in several US cities, mainly New York City and San Francisco. When whole-blood specimens were used for testing, there was no observed increase in false-positive rates. The CDC and the Food and Drug Administration are aware of these reports and have recommended continued use of rapid HIV testing on oral fluid as long as test subjects are informed of the need for additional testing in case of a positive result.
The urine test Calypte HIV-1 is an EIA test that requires administration by a physician. Positive results should be followed by confirmation with a serologic test.
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Hiv Virion And Genome
Human immunodeficiency virus 1 is a member of the Retroviridae family. It is an enveloped virus with two copies of single-stranded RNA, which have capacity to recombine. The genome contains 3 major genes that encode structural proteins: gag, pol, and env. The gag gene encodes for p24, p17, and p7, among others. The env gene encodes for glycoprotein 120 and gp 41. The pol gene encodes the enzymes reverse transcriptase, integrase, and protease. HIV-1 also has regulatory genes and genes that encode for accessory proteins that are important in viral replication and interaction with the host. HIV-2 shares the same genes with HIV-1 with the exception of vpu.
HIV-1 is divided into several groups based on phylogenetic analysis: M , O , N , and the most recently identified P group, named according to nomenclature guidelines. Group M comprises several clades: A to D, F to H, J, K, and several circulating recombinant forms . Subtype B is the most common clade in the United States. Although there is a difference in transmission rates, disease progression, response to antiretroviral therapy, and emergence of resistance to therapy among HIV groups and clades, the most recent enzyme immunoassays are able to detect non-B subtypes.