HIV tests for everyone

The director of BC’s Centre for Excellence in HIV/AIDS wants everyone to voluntarily get tested for HIV every time they go to a clinic or hospital for any examination.

Though the plan has received some support in HIV circles, some worry that it poses privacy risks and may come at the expense of other HIV programs equally critical to prevention.

Dr Julio Montaner says the new testing push is needed to keep reducing the prevalence of HIV. The sooner people are diagnosed, the sooner they can begin treatment and therefore reduce the likelihood of HIV transmission, he says.

Plus, the more people get tested, the less stigma there will be around HIV, he argues.

“If you have been sexually active in the past five years, you owe it to yourself to take a test,” Montaner tells Xtra, adding that he has secured provincial government funding for the increased testing.

“We’re looking for a whole mass movement where we normalize HIV testing,” he says.

Montaner says 9,000 people visit hospitals or clinics each day in Vancouver.

An estimated 4,500 people in BC are likely HIV-positive but don’t know it, Centre for Excellence statistics show. One in 40 gay men in Vancouver likely don’t know they’re HIV-positive, according to the Mancount report released in November 2010.

Montaner says identifying these people and treating them can reduce the risk of further HIV transmission. “Treatment is the best prevention available,” he says. “It prevents morbidity. It prevents mortality. It prevents transmission. The world has recently come together to agree this is the way forward.”

Montaner says he intends to discuss the issue at the 19th International AIDS Conference, in Washington, DC, in late July.

Dr Rick Marchand, who worked on the Mancount study, supports more testing but finds Montaner’s single focus troubling.

“The whole stop-AIDS movement has taken over,” Marchand tells Xtra.

“The whole thing has ramped up to get tested. It’s one piece of the prevention pie. There needs to be an array of other things, too,” he says. “Not just testing but other initiatives to support gay men.”

Marchand says testing is essential, but awareness programs, such as Totally Outright, run by the Health Initiative for Men to educate and support young gay men, also need support. “Yes, great, ramp up the testing,” he says. “Ramp up the education, too.”

Marchand says his research for Mancount, as well as the Community-Based Research Centre’s Sex Now surveys for gay men, shows younger gay men are less likely to get tested. “That’s alarming,” he says, suggesting more programs are needed to specifically encourage young gay men to get tested. “Is it not on their radar?

“They’re trying to generalize the epidemic and hope it will remove the stigma,” he says, referring to Montaner’s proposal. But generalized messages are not enough, he argues. Targeted messaging to specific groups, to show them why they should care and get tested, are still required.

Ken Buchanan, chair of Positive Living BC, is also concerned about Montaner’s proposal. He says such testing poses serious privacy concerns.

“When they get tested, who gets to know that information?” he asks.

He says people need to know who will have access to the information placed on their medical records.

As electronic health records become linked to other government databases, HIV status data could potentially be seen by people in ministries dealing with welfare, employment and other issues, Buchanan says. “It just spreads everywhere. Very scary.”

Buchanan says that information is supposedly covered by a personal identification, or PIN, number. “Never once has anyone asked me for a PIN number to access my data,” he maintains. “That system is not working.”

He says Positive Living BC used to be involved in official discussions about electronic health record privacy. “Eventually, they stopped inviting us,” he says.

BC Civil Liberties Association (BCCLA) policy director Micheal Vonn agrees with Buchanan.

Vonn says the Canadian Medical Association has already advised doctors they should be telling patients that any medical data going into electronic health records cannot be guaranteed to be confidential.

“That will be accessed by tens of thousands of people,” Vonn says, adding the government needs to do a better job of explaining just what information is confidential, and what control people can take over their own information.

Montaner stresses that he is not looking for mandatory testing. “That doesn’t work,” he says, reiterating that the HIV test he’s proposing will be available to everyone who voluntarily agrees to take it.

BC health and privacy rights advocates recently objected to the introduction of a controversial law that will force blood tests on patients whose bodily fluids come in contact with first responders. They called the bill ineffective and invasive. Bill 39 passed on May 31.

“Due to the sensitive nature of health information associated with communicable disease and the stigma attached to these illnesses, this bill has a serious impact on the privacy rights of individuals undergoing testing,” said BC Information and Privacy Commissioner Elizabeth Denham. “Government should only contemplate a privacy intrusion of this nature where there is a significant demonstrated need.”