Friday December 6, 2013
An article in the November issue of the journal AIDS Patient Care and STDs looked at how a variety of relationship and risk factors affect the likelihood that teens will undergo HIV testing. Interestingly, the study found that knowing a lot about HIV didn't increase testing behavior. Instead, they found that the main predictors of STD testing were being in a stable relationship and talking about HIV with a partner. Women, and teens who had had more than four sexual partners were also more likely to have been tested for HIV.
None of that is particularly surprising, but what some people may find hard to understand is that teens who were particularly afraid of HIV were less likely to get tested. At first glance, it doesn't make sense. If you're afraid of HIV, why wouldn't you want to protect yourself? The answer is simple - people who are terrified of a positive test result are also afraid of the test that could give it to them. That's why it's so important to talk about treatment at the same time as we talk about testing. Knowing that there's something you can do to keep HIV from becoming AIDS can make the thought of learning whether you have it a lot less scary.
Wednesday December 4, 2013
At first glance HIVAZ looks like a foreign word or an incomprehensible acronym. However, it actually is the new HIV information clearinghouse for the state of Arizona. The site, which was developed in partnership with a local HIV foundation, aims to give the residents of Arizona all the information they need to deal with the possibility of an HIV infection. It includes information on locating free or low cost care, testing sites, and even places that distribute free condoms. It even has links to the Arizona insurance clearinghouse, to help people who are eligible sign up for Medicaid or other insurance programs under the Affordable Care Act.
The site isn't perfect, but it is thoughtfully designed in a way that makes it easy for all Arizona residents to access important information about HIV infection, whether they don't know their status, have just learned they're HIV positive, or are looking for other types of HIV/AIDS services. I wish that more states made it this easy to locate local resources for testing and treatment. If they did, perhaps people would be able to learn their status sooner and get treated more efficiently. That is, after all, one of the most important steps towards stopping the spread of HIV.
Monday December 2, 2013
UPDATE: The ABOG has reversed their position. Obstetrician gynecologists are now allowed to treat male patients for sexually transmitted infections. This should include the type of care discussed below
Last week, I was horrified to read this N.Y. Times article about how gynecologists are being told to stop treating male patients with anal cancers or risk losing their board certifications. Instead of recognizing that the training they provide their specialists in the screening and treatment of cervical dysplasia makes them highly qualified to treat men with closely related anal lesions, the American Board of Obstetrics and Gynecology (ABOG) has stated that gynecologists are not allowed to practice on men*. If they do? Goodbye credentials.
I'd like to say that I understand where the ABOG is coming from, but I don't. I can respect that, as the Times article says, "the specialty's image was being tarnished by members who had strayed into moneymaking sidelines, like testosterone therapy for men, and liposuction and other cosmetic procedures for both women and men." I've railed against gynecologists pimping cosmetic procedures, such as hair removal, to their patients for years, and I actually fired my doctor because I found the fact that she did so inappropriate. However, forbidding the practice of purely cosmetic procedures is different than denying individuals quality care, care which would be within a gynecologist's field of practice, if the patient happened to have a female body instead of a male one.
If ABOG wants to protect the integrity of the specialty, there has to be a better way of doing it. A way that won't affect the ability of researchers to find better ways to screen and treat everyone for anal cancer. A way that won't put patients at risk, just because they're men.
*Except in very limited circumstances
Friday November 29, 2013
In recognition of the fact that as many as 80% of patients in some HIV practices are living long, full lives with their virus well under control, the Infectious Disease Society of America(IDSA) recently updated their primary care guidelines for dealing with HIV positive patients. In addition to changing the viral load monitoring suggestion to once every 6-12 months instead of once every 3-4 months, the IDSA also recommended that doctors start helping patients think more about long term preventative care. That includes things such as screening for diabetes and osteoporosis as well as preventative vaccinations for common, and not so common, infectious diseases.
In short, the guidelines reflect the fact that now that it's possible to live a long, full life with HIV, primary care for HIV positive people has to go far beyond HIV treatment. Antiretroviral drugs are great for keeping HIV infections under control, but they aren't much help in protecting people against the chronic diseases that affect aging populations -- whether they have HIV or not. In fact, they can complicate management of such conditions. That's why one of the important elements of the new guidelines is a table showing how various HIV medications interact with statins - drugs commonly used to treat high cholesterol.