HIV TESTING

First, let me say that this is just for my own information and I have nothing against anyone who is infected with the HIV virus. I recently relocated to Atlanta,Ga from Ohio and I see a lot more cases of HIV Dx here than I saw in Ohio. I have gotten into some heated arguments about testing. I was told by someone a while back before I became a nurse that when you were admitted into the hospital that all blood was tested for the virus. At first I didn't believe this but now I'm beliving this. This person said that if your test came back postive then the DR. would ask you if you have tested + before and if you say "no", then he would suggest that you have the test, the Dr. wouldn't tell you that you tested + because he didn't receive consent. Then when you are tested you find out that you are +. Now, in Atlanta I see a lot more of the Drs. asking pts. to have the test based on their symptoms, but all of these people present with different symptoms. One nurse said the Dr.s are 99% accurate. I just can't believe that these Dr.s are able to Dx these pts. with HIV because they have a hunch. Is there any truth to what this person said about all blood being tested.

All blood is not being routinely tested, as HIV testing must be consented for by the patient IN WRITING. It is also an expense that is not necessary in the majority of the population. If you are seeing more cases in Georgia, it may be that you are now living closer to an "at risk" population, such as IV drug users, a larger homosexual population or a larger number of pediatric cases. If you do find that your organization is routinely testing admitted patients, then it has a risk management dilemna on its hands.

All blood is not being routinely tested, as HIV testing must be consented for by the patient IN WRITING. It is also an expense that is not necessary in the majority of the population. If you are seeing more cases in Georgia, it may be that you are now living closer to an "at risk" population, such as IV drug users, a larger homosexual population or a larger number of pediatric cases. If you do find that your organization is routinely testing admitted patients, then it has a risk management dilemna on its hands.

This is such a convoluted question. I find it hard to believe that people are being routinely tested without their permission unless someone is running a double blind study where they are just trying to measure the prevalence in a population (without an interest in client or contact notification). It's an expensive to test to routinely write off and many people will be upset when it just suddenly shows up on their bill when they weren't even counseled. However, I think there are times when the test should be run and some of those situations won't always lend themselves to informed consent. The danger with testing remains that people will think a negative test means I don't have to apply routine precautions--always an incorrect assumption due to the window when a person can be infected without a positive test. Additionally, doing an HIV test often implies to insurers that you had an index of suspicion where this person is concerned and this can adversely affect their access of health and life insurance in the future. These are not small issues.

Finally, you may be seeing more HIV clients because of the population your hospital serves. Then your doctors may actually be wise to have a higher index of suspicion for HIV and AIDS related illnesses.

You know I find the HIV test very comparable to pregnancy testing or STD testing and it is state of the art to test for these things in concerning situations (ie a woman of child bearing age with pain below the umbilicus--whether or not she strenuously asserts her purity) and we do it and have surprising and clinically significant positives all of the time. I think we sometimes cheat clients when we only test when we can get their informed consent. However, we must see better ways to deal with misuse and prejudicial use of the medical record.

Interesting problem.

This is such a convoluted question. I find it hard to believe that people are being routinely tested without their permission unless someone is running a double blind study where they are just trying to measure the prevalence in a population (without an interest in client or contact notification). It's an expensive to test to routinely write off and many people will be upset when it just suddenly shows up on their bill when they weren't even counseled. However, I think there are times when the test should be run and some of those situations won't always lend themselves to informed consent. The danger with testing remains that people will think a negative test means I don't have to apply routine precautions--always an incorrect assumption due to the window when a person can be infected without a positive test. Additionally, doing an HIV test often implies to insurers that you had an index of suspicion where this person is concerned and this can adversely affect their access of health and life insurance in the future. These are not small issues.

Finally, you may be seeing more HIV clients because of the population your hospital serves. Then your doctors may actually be wise to have a higher index of suspicion for HIV and AIDS related illnesses.

You know I find the HIV test very comparable to pregnancy testing or STD testing and it is state of the art to test for these things in concerning situations (ie a woman of child bearing age with pain below the umbilicus--whether or not she strenuously asserts her purity) and we do it and have surprising and clinically significant positives all of the time. I think we sometimes cheat clients when we only test when we can get their informed consent. However, we must see better ways to deal with misuse and prejudicial use of the medical record.

Interesting problem.

Originally posted by MollyJ:

This is such a convoluted question. I find it hard to believe that people are being routinely tested without their permission unless someone is running a double blind study where they are just trying to measure the prevalence in a population (without an interest in client or contact notification). It's an expensive to test to routinely write off and many people will be upset when it just suddenly shows up on their bill when they weren't even counseled. However, I think there are times when the test should be run and some of those situations won't always lend themselves to informed consent. The danger with testing remains that people will think a negative test means I don't have to apply routine precautions--always an incorrect assumption due to the window when a person can be infected without a positive test. Additionally, doing an HIV test often implies to insurers that you had an index of suspicion where this person is concerned and this can adversely affect their access of health and life insurance in the future. These are not small issues.

Finally, you may be seeing more HIV clients because of the population your hospital serves. Then your doctors may actually be wise to have a higher index of suspicion for HIV and AIDS related illnesses.

You know I find the HIV test very comparable to pregnancy testing or STD testing and it is state of the art to test for these things in concerning situations (ie a woman of child bearing age with pain below the umbilicus--whether or not she strenuously asserts her purity) and we do it and have surprising and clinically significant positives all of the time. I think we sometimes cheat clients when we only test when we can get their informed consent. However, we must see better ways to deal with misuse and prejudicial use of the medical record.

Interesting problem.

Thanx for both of the responses that I received. I guess I didn't think of the population that I am working with and the demographics. Also, what further led me to believe this was that while we were discussing this at work a coworker stated that this had happened to her and that her Dr. stated "your HIV test was negative", and she stated that she hadn't consented to it, but, she was pregnant at the time. Oh well, I guess these Drs. who can't Dx Chronic Fatigue Syndrome knows what they are doing when it comes to HIV.

[This message has been edited by sheripa (edited March 05, 2001).]

Originally posted by MollyJ:

This is such a convoluted question. I find it hard to believe that people are being routinely tested without their permission unless someone is running a double blind study where they are just trying to measure the prevalence in a population (without an interest in client or contact notification). It's an expensive to test to routinely write off and many people will be upset when it just suddenly shows up on their bill when they weren't even counseled. However, I think there are times when the test should be run and some of those situations won't always lend themselves to informed consent. The danger with testing remains that people will think a negative test means I don't have to apply routine precautions--always an incorrect assumption due to the window when a person can be infected without a positive test. Additionally, doing an HIV test often implies to insurers that you had an index of suspicion where this person is concerned and this can adversely affect their access of health and life insurance in the future. These are not small issues.

Finally, you may be seeing more HIV clients because of the population your hospital serves. Then your doctors may actually be wise to have a higher index of suspicion for HIV and AIDS related illnesses.

You know I find the HIV test very comparable to pregnancy testing or STD testing and it is state of the art to test for these things in concerning situations (ie a woman of child bearing age with pain below the umbilicus--whether or not she strenuously asserts her purity) and we do it and have surprising and clinically significant positives all of the time. I think we sometimes cheat clients when we only test when we can get their informed consent. However, we must see better ways to deal with misuse and prejudicial use of the medical record.

Interesting problem.

Thanx for both of the responses that I received. I guess I didn't think of the population that I am working with and the demographics. Also, what further led me to believe this was that while we were discussing this at work a coworker stated that this had happened to her and that her Dr. stated "your HIV test was negative", and she stated that she hadn't consented to it, but, she was pregnant at the time. Oh well, I guess these Drs. who can't Dx Chronic Fatigue Syndrome knows what they are doing when it comes to HIV.

[This message has been edited by sheripa (edited March 05, 2001).]