AIDS Question

graduatemay2004 · Mar 15, 2004

I am aware of the high high cost, which many many years down the road may have been worth the cost versus what the cost could become when we do finally have to do more. I understand all your points, and they are very reasonable. On the other hand it makes it sound like we should all be scared to get an AIDS test or like it actually advises people against the AIDS test for purposes of insurance, ect. How is this going to help stop the spread? This will all make the problem worse in the long run, and I still believe we need to start making changes now. Yes, your right, how awful for people to lose a job or insurance, but how even more terrifying for someone who could have known they were HIV positive to pass it to 3 or 1 more person! This is a touchy subject and I thank you for your replies.:)

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..........................

Anniekins · Mar 15, 2004

Two Words: Universal precautions :nurse:

Agnus · Mar 15, 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

It is not done simply because there is federal law protecting the rights of the individual involved. It is unnessary to test. Use universal precautions to protect yourself and patients. Individuals have the autonomous right to not know if they have a disease. It may seem crazy to not want to know but many people do not and it is thier right. The testing is expensive and to what end would it serve. You would still use universal precautions knowing or not.

Exposure is exposure. You have no greater chance of sero converting with the knowledge or without it. Knowlege of the presence of disease does not reduce incidence of exposure.

kids · Mar 15, 2004

What happens if a person refuses?

People have the right to know or not know if they carry the virus. Even tho it is (often eventually) fatal. It is not against the law to have HIV, it is not against the law to unknowingly pass on the infection.

Testing is expensive and the expense doesn't end with the results being given. Who is going to pay for it all? Please don't say the government, we can't even meet the basic healthcare needs of citizens as it is without the added financial burden.

What happens when a person tests positive?

Since the whole point to routinely testing everyone is to identify the infected to benefit society and reduce the spread what will we do with the information? Many people who engage in high risk behaviors do not change their lifestyles after testing positive dispite counselling. Shall we tattoo it on their forehead?

graduatemay2004 · Mar 15, 2004

It would serve the people who do not know they have the disease by abstaining from behaviors to pass on the disease. Yes universal precautions on every patient regardless! My point is not tring to say routine tests should be done to protect nurses, no nurses must use universal precautions regardless. My point is stopping the spread by informing people of thier HIV status. Yes many would still engage in risky behaviors, but many would not. This is the topic of my research paper and thier is many accredited journal articles, books, ect. saying routine testing should be done. This is still highly debated and may change some day. I'm not saying anyone is wrong in what they are saying because the law exists like it is for a reason, but more and more they are coming to realize we may not be handling this issue in the right way.

It is not done simply because there is federal law protecting the rights of the individual involved. It is unnessary to test. Use universal precautions to protect yourself and patients. Individuals have the autonomous right to not know if they have a disease. It may seem crazy to not want to know but many people do not and it is thier right. The testing is expensive and to what end would it serve. You would still use universal precautions knowing or not.
Exposure is exposure. You have no greater chance of sero converting with the knowledge or without it. Knowlege of the presence of disease does not reduce incidence of exposure.

suzanne4, RN · Mar 15, 2004

But why are you concerned just with HIV/AIDS? Look at all of the other STDs, women can become sterile because of them. They also spread. How about TB? Do we test everyone? No........................................

If you look at who is advocating these tests, they are usually NGOs. In the absolute perfect world, things could possibly be different. But everyone has the right to do what they want to do with their body. Being a nurse you cannot judge by what you would do in the same position because you are not on the other side. Work for a year in a hospital environment and then you will see why we are all giving you our answers. And if you haven't noticed, all of them have been opposite your thoughts. We are all entitled to our opinions AND we have the experience to back it up. I have twenty five years of hospital experience, from inner city receiving hospitals, to plush plastic surgery clinics. You wanted our opinions and we gave them to you. Sorry that they weren't what you were looking for. My answer is not going to change one bit..........................

:balloons:

caroladybelle, BSN, RN · Mar 15, 2004

And you pbviously didn't read my post....which addresses many of those issues.

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.

MRSA/VRE/syphilis/Chlamidia are mostly more common, much more easily spread and we do not test for those routinely. Same with Hepatitis which has a high fatality rate. Syphilis can also be very life/health threatening

I regret that many of our answers are not in agreement, but when you ask a public BB for in opinion, you should expect a variety of opinions and not all will agree.

fergus51 · Mar 15, 2004

I think it's just a matter of ideal vs reality. Ideally, we would screen patients for everything. In the real world it just isn't practical. I mean, would you support mandatory HIV testing for everyone if the money had to come from public health programs or prenatal care or ER budgets? Unfortunately that would be the reality.

graduatemay2004 · Mar 17, 2004

Thank you all for your posts! As a student I'm still sorting through a lot of information, and I appreciate all the expirienced answers you've all given me.:) :)

Robinette · Mar 20, 2004

Are you suggesting mandatory HIV testing? No can do. A patient has the right to refuse any and all medical intervention and/or tests, provided it's not an emergency situation. Can't mandate a blood test. Against the law.

And, I don't think mandating the test is going to make a significant difference in the spread of AIDS. There is so much public information and outreach materials about AIDS and HIV testing that one would have to be living in a cave in Siberia not to be aware of all the associated issues.

Robinette · Mar 20, 2004

Are you suggesting mandatory HIV testing? No can do. A patient has the right to refuse any and all medical intervention and/or tests, provided it's not an emergency situation. Can't mandate a blood test. Against the law.

And, I don't think mandating the test is going to make a significant difference in the spread of AIDS. There is so much public information and outreach materials about AIDS and HIV testing that one would have to be living in a cave in Siberia not to be aware of all the associated issues.