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Handy HIV tests help more learn status




 

Incredible advances in the treatment and prognosis of HIV infections mean that a diagnosis is no longer quite as terrible as it once was - and getting tested for it is far less fraught with dread than it was a decade or two ago.

But roughly 1 in 6 San Francisco residents who are HIV-positive doesn't know it, and nationwide, the number is even higher - 1 in 5 Americans with HIV, or about 200,000 people, is unaware of the infection.

That's bad news for those individuals who could be taking life-saving drugs to stall their infections. It's bad news for their communities, too, because people with untreated HIV in their blood are much more likely to spread the virus than those who have the infection under control.

So testing has become a major focus of local and national plans to curb the HIV epidemic. In the past month, the U.S. Centers for Disease Control and Prevention began a new program to offer HIV testing in pharmacies, and shortly after, the U.S. Food and Drug Administration approved the first at-home HIV testing kit, which will be widely available in Bay Area pharmacies soon.

Greater opportunities

Those new options, combined with efforts to beef up already-existing community testing programs, means people have more opportunities than ever to find out their HIV status.

"The sooner people get on treatment, the better their long-term health is going to be, and if they get tested sooner, they can get into treatment sooner. Plus, with treatment, they can reduce chances of spreading HIV by 96 percent," said Dr. Brad Hare, medical director of the HIV/AIDS ward at San Francisco General Hospital.

"So it's got a public health benefit and a personal benefit," he said. "It all comes down to testing."

The CDC intends to reduce the percentage of Americans who don't know their HIV status from the current 20 percent to 10 percent by 2015. San Francisco is already ahead of the rest of the country as far as people being aware of their status, but city public health authorities still are pushing for increased testing.

Easing burden of testing

Just six years ago, HIV testing was a burdensome process that involved pretesting counseling and written consent forms. Public health agencies began relaxing some of those rules to make the process easier and more convenient.

Now, HIV tests have been done in bars and dance clubs during public health promotional events, and many people get tested during their regular health exam from their family doctor. Two years ago, San Francisco General Hospital started a program to test people who come into the emergency room and meet certain high-risk criteria for contracting HIV.

The new CDC pharmacy program, announced in late June, will allow people visiting one of 24 participating businesses in the United States - including Mike's Pharmacy in Oakland - to get what's known as a "rapid test" done by a pharmacist or other trained employee. Those tests use a saliva sample and can take just 20 minutes to produce results, although positives must be confirmed with a blood test.

"Millions of Americans visit pharmacies every week. It's a largely untapped potential to deliver HIV testing," said Paul Weidle, a CDC epidemiologist who is leading the pharmacy project. "To end the HIV epidemic, it's essential to test and diagnose everyone and get them to care. The testing part is the first step in that."

Rapid-test format

The at-home kit also uses the rapid-test format, and as of July 3, anyone can buy the OraQuick test without a prescription. The rapid tests can produce both false positives and false negatives. People who get a positive result will need to have a second test done by a doctor. And people who test negative may want to test themselves again in a month or two, especially if they believe they're at risk of being infected.

The increased testing options are aimed at two main groups of people: those who have never been tested and don't know their HIV status, and those who are at high risk of contracting HIV and should get tested regularly.

The CDC recommends that all adults who aren't at high risk be tested at least once in their lifetime for HIV. But men who have sex with men and don't use condoms or also use drugs - both behaviors that are associated with an increased risk of developing HIV - should get tested at least twice a year.

Targeted population

In particular, public health officials said they'd like to focus on people who may not know that they're at heightened risk of contracting HIV. Certain communities have a higher viral load than others - meaning there are more people in that community who are infected and don't have the virus under control with medication, either because they don't know they have HIV or they aren't being treated for it.

In most parts of the United States, minority women and minority men who have sex with men are particularly at risk because of their exposure to people with high viral loads - and they may not know it.

"There are a lot of people who just haven't had the opportunity to learn about the disease or what puts them at risk, or their information is out of date," said Dr. Nicholas Moss, director of clinical prevention in the HIV prevention section of the San Francisco Public Health Department.

"There are people who don't realize they're at risk because they don't realize their partners are at risk for HIV. That's a big concern," he said. "By increasing the number of people that are aware of their status and on treatment, we suspect that we can really turn the corner on the epidemic, certainly in this country."

Receiving the results

Public health and patient advocates said it is undoubtedly beneficial to be able to offer more options to people to get tested. But they cautioned that HIV still isn't an easy diagnosis to live with and testing shouldn't be taken too lightly.

Moss recommends that people who are taking an at-home test make sure they have a friend or family member available to talk to in case they test positive - much like they would if they were taking a pregnancy test at home.

"HIV is still a lethal infection and can lead to incredibly debilitating illness for people who delay treatment," Moss said. "The changes in how we approach testing reflect the fact that when we identify people who have HIV, we have very good treatment. The benefits of knowing your status are now clearer than ever."

Erin Allday is a San Francisco Chronicle staff writer. E-mail: eallday@sfchronicle.com




 


Copyright © 2012 -San Francisco Chronicle, Publisher. All rights reserved to San Francisco Chronicle Press. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the San Francisco Chronicle, Permissions Desk, 901 Mission Street, San Franciso, CA 94103. You may also send a fax to (415) 495-3843, or send an email to San Francisco Chronicle.

Information in this article was accurate in August 12, 2012. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.