COMMENTARY ON HIV TESTING NEGLECTS THE EXISTENCE OF MANY BARRIERS

Arthur Caplan and Glenn McGee's May 21 Perspective column on making
HIV testing routine is not well thought out and neglects many
barriers that exist in addressing the HIV epidemic.

I agree that everyone should know their HIV status.

Physicians are currently able to, and should, routinely test their
patients. However, Caplan and McGee miss the mark in understanding
how the epidemic can be managed.

The majority of the projected 250,000 unsuspecting HIV infected
people will not be reached with routine testing by primary care physicians.

Many at-risk people are poor, disenfranchised, uninsured and unlikely
to be in the regular care of a physician.

Active users of injected drug are not typically connected with any
system of care and must be reached through community-based outreach
by individuals they trust.

I strongly disagree with the conclusion made by Caplan and McGee that
the HIV stigma no longer exists.

Have they asked people living with HIV if they believe the stigma is
gone? HIV is associated with sex and drug use, and people do make
assumptions about infected individuals. There is stigma and judgment
and, yes, some fear of transmission.

I am particularly confused as to why we would make it a requirement
of college entrance to get an HIV test. Who will have access to this
information? And why?

Lastly, who will pay for all the HIV tests, the data collection and
the care of the uninsured with HIV? New York is facing a $20 million
cut in federal Ryan White money, a primary funding source for the
AIDS Drug Assistance Program and support services. There are people
in the United States right now who know their HIV status and cannot
access appropriate care.

While we should raise awareness among the general public, we must
continue to support community-based organizations that are successful
at bringing the highest-risk individuals into testing and care
through targeted, culturally appropriate messages that break through
barriers to HIV awareness.

MICHELE MCCLAVE

Executive Director

AIDS Council of Northeastern New York

Albany