"Testing, Testing..."
I've been avoiding writing this entry though I feel compelled to write it, so I'm just getting it out of the way. Hopefully, everyone has heard that the CDC announced this week new recommendations for HIV testing, arguing for the routine HIV-testing for all adults. This makes me nervous for various reasons.

Before, you needed to provide written consent for an HIV test. Now, the CDC says that should not be required (though I wonder about the existence of state laws that require it). Furthermore, they say that pre-test counseling should not be required. They see these as impediments to testing, as "barriers" as some articles say.

As a gay man, one thing that bugs me more than anything else when working with a doctor is when they encourage me to be tested for HIV without ever asking one question about my sexual activities. You're gay? Let's test you for HIV." I've turned down the test in those cases because I despise such connections being made.

The first time I was tested for HIV, I did not sign the form providing consent. But I was tested anyway. You can see from where my distrust of this process arises. The second time I was tested was after Blane died. It was a few months after his death, and I knew I should be tested and was absolutely terrified.

During the counseling session beforehand, when the guy asked why I was wanting the test, I told him that my partner had died of AIDS. Then, he asked me what activities we engaged in that put me at risk. I detailed every moment I could think about that might have been an issue, and the guy laughed. He apologized, told me that he didn't think I had anything to worry about, but drew blood. After getting the results two weeks(!) later and after thinking about the process for a couple of weeks after that, I was angry. I truly had not engaged in any risky activities, but I also truly believed I was HIV-positive. I had bought into our society's message that gay equaled AIDS.

I decided then and there not to buy into that message again.

Some articles I've read talk about the fact that AIDS no longer suggests fatalism. True. But they also talk about the reduction of stigma. What?!? In some ways, I wonder if the stigma today is worse because so few people know anyone who is HIV-positive anymore. It seems like fewer and fewer people know someone who has died from AIDS. AIDS seems to be a disease of "those people" again.

I'm worried about what this is going to do when it comes to health insurance, when it becomes a pre-existing condition. I am not saying that people should not be tested because they might not be able to get health insurance later, but I'm not convinced that a lot of people have thought deeply about connections between testing and insurance.

Furthermore, there are the laws criminalizing people for transmitting HIV. In the 80s, when I was in college and having sex quite regularly, the belief was that you do what you need to do to protect yourself. Now, we're in a place where people are trying to use laws and the state for protection. Yes, knowingly transmitting HIV is wrong. But what about someone who chooses not to be tested and then transmits HIV? Are we getting close to the point where that could become a criminal act? I worry about the kind of surveillance encouraged by increased testing.

Finally, the organizations that provide services to those living with HIV are already overburdened. They don't get the money they need to do they work they want to do. And these new guidelines mention nothing about increased services. It's like those who fight to make abortion illegal without doing anything to help once the kid has arrived. This is why I get worried about this as a surveillance measure, again.

Testing is a great idea in a lot of ways, but it's not going to solve everything. This is one of those causes that is going to have a lot of effects, and I'm not convinced that people have really thought about them.

I've done some rambling here, I know. But a lot of thoughts are swirling in my head. I'm not sure what to do or say about any of them, yet.
- posted by Nels @ 3:31 PM | | | Link |