AIDS Question

fergus51 · Mar 12, 2004

It isn't done because it is expensive, time consuming, not all that accurate early on and does still have a lot of stigma associated with it. People have every ability to get checked if they chose, but there is only so much screening we can do in the hospital setting.

graduatemay2004 · Mar 13, 2004

I realize the stigma involved and thus I stated that people still would have the strict confidentiality they are entitled to. However, I believe that although it is expensive the hospitals provide us with rubber gloves and enforce universal precautions (which was at one time highly debated do to cost). Yes it is expensive but it protects us, as would AIDS screening with every entry into the hospital. I also realize it takes 3mo-6mo for seroconversion to take place, and they go up to a year to be safe, but the next time that patient came to the hospital it would be caught then. I still believe we need to stop being scared and face this problem more aggressively. I appreciate any opinion on this matter and I thank you for your reply.

It isn't done because it is expensive, time consuming, not all that accurate early on and does still have a lot of stigma associated with it. People have every ability to get checked if they chose, but there is only so much screening we can do in the hospital setting.

suzanne4, RN · Mar 13, 2004

If you know that you are caring for a patient that is positive for HIV, does your care fo the patient change? It shouldn't. Besides HIV/AIDS, there are many other diseases that can be transmitted to staff at the hospital, using the same routes. What about Hepatitis? If you are using universal precautions with every patient, you should be protected. And many patients, if they are considering having an HIV test done will do it at an out-patient lab, not at a hospital where they are being admitted to and everyone can see their chart. You also have to take that into account because of the stigmas connected to the disease. Currently, the only way that a hospital can require a patient to have an HIV test is if a health care provider gets pokes with a dirty needle, or accidentally cuts themselves in the OR. Automatically blood is drawn on the aptient right at that time, and then also on the employee.

Another thing to think about. Is it mandatory to have a mammogram every year? Can we require that someone does? No. Breast cancer definitely kills.

Hope that this helps. :balloons:

suzanne4, RN · Mar 13, 2004

And unfortunately, when are things stricly confidential in the hospital setting? Sure they are supposed to be but how many people are looking at your chart on a daily basis, try to watch one chart for even an hour on a busy unit and see how many people handle that chart...............That is one of the reasons that patients don't always give us all of the proper information that we need for caring for them. Just because of this one fact.

And if you happen to be in a teaching hospital and there are students from all different disciplines using your chart. Another thing to think about about. Also what happens if the patient comes up with a false-positive before another test is done. What happens then?

fergus51 · Mar 13, 2004

I realize the stigma involved and thus I stated that people still would have the strict confidentiality they are entitled to. However, I believe that although it is expensive the hospitals provide us with rubber gloves and enforce universal precautions (which was at one time highly debated do to cost). Yes it is expensive but it protects us, as would AIDS screening with every entry into the hospital. I also realize it takes 3mo-6mo for seroconversion to take place, and they go up to a year to be safe, but the next time that patient came to the hospital it would be caught then. I still believe we need to stop being scared and face this problem more aggressively. I appreciate any opinion on this matter and I thank you for your reply.

HIV screening wouldn't protect us for the reason you mentioned (a year is a long time), so universal precautions are still the only way to ensure our safety which makes HIV testing an unecessary cost. And when you consider how difficult it is to spread HIV to a healthcare worker, I can't see approving that, especially when Hep C is much more common and easily spread.

And when I say stigma, I am not talking about the general population, I am talking about the people in the hospital (nurses, docs, etc). You would not believe the comments I have heard from my fellow nurses about HIV infected patients. If I were HIV positive in my hospital, I would not want the staff to know. It's sad to say, but there are a good number of nurses who treat these patients VERY differently.

Certain groups are screened (all pregnant women for instance), but although HIV is a problem, it is not enough to warrant testing everyone. It just isn't that common, except among certain groups. If you aren't using IV drugs, aren't from an area like Subsaharan Africa, aren't having multiple partners or sex with gay/bi men or IV drug users, are using protection, your risk of HIV is very low. Sure it's possible you still contracted it, but we don't focus money on everything that is possible. I can't see wasting all that money in the hopes of catching that odd case, rather than focusing it where it needs to be. Healthcare funding is all about getting the most bang for your buck, and testing everyone who walks through the door for a fairly uncommon disease is a waste.

caroladybelle, BSN, RN · Mar 13, 2004

Just curious of those nurses out there that think everyone coming into the hospitals should be AIDS tested? Why isn't it just done like other blood test so people can be informed and decrease the spread of HIV. I'm not saying people wouldn't still have the right to their confidentiality of others knowing, but shouldn't they know so they can take precautions in their life. And why do they tell you to get tested if your high risk? Many people think there safe, but a husband or wife may have committed an infidelity just once possibly. Whats wrong with safegaurding ourselves? I realize as a nurse you always use universal precautions and even if this was the case there is still the time for seroconversion to take place. So even if the person tested negative they could still be aquiring HIV, and thus always universal precautions. Anyway why as a society are we more scared to know than to help stop this disease from spreading!!! :stone

We don't do testing for all other diseases.

We do very few RPRs, we do not do random ANA titers, we do not swab everyone for Chlamydia (sp?). Is it not important to check for syphilis, or screen for lupus or chlamydia - illnesses that can be life/health threatening, can cause sterility?

We do not test every patient for VRE/MRSA, diseases that we have much more chance of catching and spreading, and diseases that the patient/nurse should be aware.

The fact is do we need to know about HIV unless it relates to diagnosis? No, we do not, because it should not change precautions used. Would a patient knowing that they have HIV change their behavior? Debatable.

As someone that worked ID in the mid1990s, the people that know that they might have HIV, and are responsible individuals take precautions and request tests. The ones that are irresponsible do not and will not. Will forcing the irresponsible to acknowledge their disease state making them behave responsibly - rarily, from what I have seen. Some even go out with a vengence and try to infect others. And the positive test results triggered that vengence.

As far as infidelity, many spouses suspect their mates and yet do nothing, because of denial issues. If they wish to get the test, more power to them. But requiring it in the hospital....really not an effective measure. Some people would refuse hospital care when they need it, and it could be more detrimental to them receiving the care that they need.

elkpark · Mar 13, 2004

Re: confidentiality of medical records in the hospital, we all know that one of the first things you have to sign when you get admitted is the ROI form giving consent to release your records to your insurance company for reimbursement purposes. If we tested everyone for HIV (and everything else that would make just as much sense and accomplish just as little), the insurance companies would have access to that information and be free to find a way to quit covering all the people who they could see would cost them money down the road.

Years ago, when HIV was first becoming an issue, I attended a presentation in which the speaker said that all healthcare professionals should know their status, and we should all get tested, if only to set a good example for the general public. I was young then, and a new nurse :) , and that made a lot of sense to me, so, the next time I was in my doc's office I told him about this and asked about getting tested.

He said right away that he didn't see any reason for me to get tested, BUT, if I really felt strongly about this, I should go to the public health office in the larger city nearby, where they offer anonymous testing to the public. He said flat out that he would NOT order the test for me just out of curiosity, because, once that info was in my record, he couldn't keep my insurance company from finding out that the test had been done. And even if the results were negative, a lot of insurance companies took the position that if you got tested there must be some good reason why you thought you needed to be tested (i.e., high risk behavior), and they would drop your coverage for that reason alone ...

I don't have any personal knowledge of whether that's true or not, but that's what he told me, and he was v. serious about it ...

bellehill, RN · Mar 13, 2004

There is definitely a stigma among some healthcare workers who care for AIDS/HIV patients. Personally I don't care one way or the other, they are my patient no matter what their problem is.

I would be more interested in a blood test that measures alcohol intake over a certain period...kind of like a HgbA1C for alcohol. I would love to know my "social" drinkers are going to go into DTs before it happens.

donmurray · Mar 13, 2004

And if done properly, HIV/AIDS testing will include counselling regarding the outcome of the tests. Imagine counselling sessions for every patient, every admission...Not practical.

graduatemay2004 · Mar 14, 2004

Unfortunatley my post was mis-read. I am not saying screening should be done because of the health care workers caring for these patients. Yes you always use universal precautions regardless! No, what I'm saying is to put a better handle on AIDS is to test everyone so to cut down on AIDS being spread not in the hospital but in anyones life who carries the disease( Such as to a spouse, boyfriend, girlfriend, ect for example during intercoorifice). Still with strict confidentiality and respect to that patient. Of coorifice I wouldn't treat anyone with AIDS or anything else any different! Also getting a mammogram for breast cancer wasn't quite the right example because yes it kills but we don't pass it to one another through sexual contact or from blood to open wound contact.

If you know that you are caring for a patient that is positive for HIV, does your care fo the patient change? It shouldn't. Besides HIV/AIDS, there are many other diseases that can be transmitted to staff at the hospital, using the same routes. What about Hepatitis? If you are using universal precautions with every patient, you should be protected. And many patients, if they are considering having an HIV test done will do it at an out-patient lab, not at a hospital where they are being admitted to and everyone can see their chart. You also have to take that into account because of the stigmas connected to the disease. Currently, the only way that a hospital can require a patient to have an HIV test is if a health care provider gets pokes with a dirty needle, or accidentally cuts themselves in the OR. Automatically blood is drawn on the aptient right at that time, and then also on the employee.
Another thing to think about. Is it mandatory to have a mammogram every year? Can we require that someone does? No. Breast cancer definitely kills.
Hope that this helps. :balloons:

suzanne4, RN · Mar 14, 2004

Unfortunately, I don't think that you have been around hospitals too long.

When you have fifty people reviewing your chart in one way or another, strict confidential reports do not exist. In the US, you can actually be denied insurance because you were tested for HIV. And refused a job because of it also. The employer won't tell you that, but the wall does exist.

HIV does not kill any more than breast or cervical cancer if you look at statistics. Or even heart disease. I am also not sure if you are aware of the costs involved if you were to screen every patient. Remember that if you do an Elisa, it can give you a false-positive. You follow with a Western Blot test for confirmation. But what happens to that patient when that first test comes back positive. Any records in the hospital are shared with your insurance company. What do you do then? Unfortunately, not everyone in the world is as accepting of people with HIV/AIDS. There is still quite a stigma with it, no matter what country you are in.

These are just a few other things to consider. We don't live in the perfect world..........................