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Last Updated

06 Nov 2002


With no innovative strategies to promote widespread HIV testing, even public health officials in the United States find that many HIV carriers have no knowledge of their infection status.  As such these persons receive no treatment and unknowingly transmit the infection to others.  

What follows is an excerpt from a Laurie Garrett article on Second National HIV Prevention Conference, Atlanta, Georgia, August 12-15, 2001. 

- Ralph R. Frerichs

Source: Garrett, Laurie. Officials' Dilemma in AIDS Fight -- Treatments vs. concerns of spread,  Newsday, New York, August 16, 2001. 


This week the CDC's Dr. Michael Campsmith reported the results of surveys of 18,150 HIV patients from 12 regions, including New York City. "Forty percent were diagnosed with HIV within a year of going into frank AIDS," Campsmith said in a news conference. "Which means they went a decade without treatment." The finding indicates that these people first learned they carried HIV about a decade after they became infected. The virus develops into AIDS about 10 to 11 years after first infection, if the individual is not treated.

Figure illustrating silent HIV transmission

The article goes on to describe a report by Leo Hurley of Kaiser Permanente, the nation's largest HMO, documenting similar lack of early detection.  

A review of the charts of 434 of the 12,000 HIV-positive individuals enrolled in the Kaiser system found that 44 percent weren't diagnosed until they had actual AIDS. Examination of old charts revealed that many of the patients had signs of early illness that were missed by their doctors. And in some cases the physician recommended an HIV test years earlier, but the patients refused.

The importance of the Kaiser findings, Hurley said, is that, "even with access to quality health care, HIV may go undetected for years."

This flies in the face of long-held assumptions in the AIDS community that late diagnosis and treatment were because of poverty and lack of access to health care. Dr. Carol Ciesielski of the Chicago Department of Public Health surveyed 1,024 men who were treated for syphilis in the city's clinics between January 1998 and December 2000, 83 percent of whom were heterosexual. Despite the fact that sexual behavior can make one vulnerable to syphilis and HIV, a third of the heterosexual men and a fourth of the gay men with syphilis had never had HIV tests.

The AIDS obstructionists (August 2001 commentary)