Angry Doctor

Tuesday, December 18, 2007

Them 7

An article on the "voluntary, opt-opt" HIV testing scheme in Today today casts some light on some of the problems Singapore faces in tackling the HIV/AIDS problem:

(emphasis mine)

An Aids test? 'It isn't for me'
Attitudes towards managing HIV must change, as voluntary screening pilot starts
Sheralyn Tay

THE admission form looks the same — with the addition of a clause that could be crucial in the fight against Aids: "I do not want to be screened for HIV".

From yesterday, all adult in-patients at Changi General Hospital (CGH) had to sign against that statement if they did not want to be tested for HIV.

But even as Singapore's pilot voluntary, opt-out HIV-testing scheme takes off, it seems more must be done to shift society's attitudes on managing the disease.

Most of the visitors at CGH whom Today spoke to were unaware of the scheme to increase HIV-testing rates. Of the eight polled who thought it was "a good idea", five would not consent to testing because they "did not fall into the high-risk groups" — the kind of reaction HIV-prevention advocates are trying to change.

The process at CGH is simple enough: Conventionally, all patients being admitted sign a General Consent for Admission Form, which now has the added clause.

A CGH spokesperson said: "The consulting doctor will inform the patient of the HIV screening, provide him or her HIV Testing brochures to read, and answer any questions."

If patients, or an authorised person, decline the test, they sign next to the opt-out option. Otherwise, depending on their ward class, they will pay between $6 and $23 for the test.

According to CGH, it is still too early to disclose the take-up rate. But according to visitors like Mr Ong, 56: "It's not for me … It's good for single, young men only. Elder and married men like me who have only one partner are more decent and safe."

Mr C K Koh, 54, said: "Testing isn't for me — the more you know, the more problems there will be."

But Action for Aids (AfA) executive director Lionel Lee stressed that HIV is everybody's problem and hopes the testing agenda will take root. "Once testing becomes a normal thing, like any test for a chronic disease, it will be more accepted by the population."

Other hospitals, such as Singapore General Hospital and K K Women's and Children's Hospital will roll out voluntary, opt-out HIV testing for inpatients in the next few months, in line with HIV prevention guidelines from the American Centres for Disease Control.

AfA's anonymous testing programme had just 500 tests done when it started in 1997. It was 6,046 last year, and Mr Lee expects a 10-to-20-per-cent rise on that by the end of the year.

Yes, of course everyone should have a HIV test, but *I* don't need one. People like me don't get AIDS; only people like *them* do.

Well, if people who think they can't be HIV-positive will not opt to be tested, and those who think they may be HIV-positive won't either, then angry doc really wonders if a "voluntary, opt-out" scheme will really make a difference in the grand scheme of things. In any case, such a scheme will only cover those who are admitted to a hospital, and not pick up asymptomatic 'carriers', who presumably make up the majority of HIV-positive patients.

Given that anonymous HIV testing had been available for about ten years, accessibility and cost to testing are probably not a major obstacle in the fight against HIV/AIDS. Until the reason behind people's reluctance to testing are identified and addressed, angry doc doubts voluntary opportunistic screening of a small segment of the population (less than 10% of the resident population if all hospitals implement such a scheme) will reduce the incidence of new HIV infections.



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