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Frerichs, R.R. Routine Hospital HIV Testing and Prophylactic AZT.

SEA-AIDS Network, December 6, 1997

Posted in response to:

SEA-AIDS, December 4, 1997

From Praneed Songwathana, Songkla, Thailand

I appreciate your comments on routine testing for hospitalised patients. I have been interested in this issue as well, since I have been involved with research on AIDS care at hospital, home and community levels.  During my career as a nurse, I found this issue of great concern among health care workers regarding ways to protect from HIV risk and danger to contact. Universal precaution may not be completely used among all hospitalised patients and the greater precaution techniques were used in patients with HIV/AIDS.

I do not agree that testing should be done in all patients unless there is concern that they are prepared for the outcome of testing. As far as I know, most hospitalised patients have not been informed formally or informally about the HIV test and when the result shows positive blood test, the psychosocial issue is of great concern and also causes much trouble. 

I am now preparing a project to develop a possible system for testing and counseling and also follow-up patients in my hospital in southern Thailand.

Your suggestions and ideas would be very appreciated.  I look forward to hearing from you.

Praneed Songwathana

Faculty of Nursing, Prince of Songkla University

Hatyai, Songkla, Thailand 90112

R.R. Frerichs Posting

Thank you for your thoughtful response to my posting about testing in a hospital setting. I typically do not offer detailed solutions, but rather try to pose the problem and encourage experimentation that discovers the best or most appropriate solution. If enough groups do enough experiments, and the results get widely disseminated, then we all benefit. 

What continues to trouble me, however, is the narrow view that many hold in the HIV/AIDS community, that limits their imagination of potential solutions. There is a near-religious voicing of human rights concerns (usually focused more on the rights of the infected to avoid detection than the rights of susceptible to remain free of infection) that seems to permeate most policy discussions in the HIV/AIDS arena. The psychological effect is a narrowing of thought, a unwillingness to experiment, and as a result, a shortage of truly effective intervention or prevention strategies. Perhaps this is why we continue to see a dramatic rise of HIV in various regions of the world (up from a cumulative world total of about 13 million at the end of 1992 to a prevalence of 30 million at the end of 1996). 

We are experiencing similar ideological debates in the reproductive field (i.e., pro- and anti-abortion groups), in animal production (i.e., pro and anti-fur animal groups), and even in biological/medical experimentation (i.e., animal rights groups). The inevitable consequences of these intense interactions are slowing of research and limitations on programs, effects that hurt many people.

Ideology after all does have its price. I encourage you move forward with your investigations, keeping in mind both cost and sustainability as well as epidemiological effectiveness, and let others know of your findings.