Monday, March 24, 2008

how not to give an HIV test

Last week, I completed my training for HIV counselor certification. The training was a very eye-opening experience for me, but I predict that doing the actual pre-and post-HIV test counseling will be much harder than the role plays I practiced in class.

Part of the training included a lecture on how people should be praised when they come in to get a test. For some of these people, it is a very difficult step to take in their lives and congratulating them for it will only solidify their 'desire' (for lack of better word) to take the test.

This reminded me of the time I asked for an HIV test from my primary care doctor.

What a lot of people don't know is that an HIV test is NOT automatically part of your annual physical (on that note, you also don't get tested for all STD's unless you ask). You have to specifically request it. So after having been intimate with my partner for quite some time (and without a condom after monogamy was established), I decided to ask my doctor for an HIV test at my next physical.

This wasn't the first time I had asked her. Dr. E has been my doctor since I moved to DC. She had tested me before. But every year I see her for a physical, she asks me questions about my sexual activity, assessing my risk. Before I was in a relationship, Dr. E tested me for HIV, no questions asked. But after having been in a monogamous relationship, she saw no need for it.

Me: I'd like an HIV test too, please.
Dr. E: Why?
Me: Because I'd like to know my status.
Dr. E: But you just told me that you and your boyfriend are monogamous and have been for nearly a year. You don't have any other risk factors. I don't think you need it.
Me: Yes, but I want it.
Dr. E.: Ok, but I don't feel that it is necessary.
Me: I still want it though.

The truth is this--I had a pretty good feeling that I was negative. Yes, I hadn't put myself at risk since my last HIV test. But that wasn't the point. The point is that my doctor has no idea whether or not my boyfriend is cheating on me. Yes, I know that isn't very likely. But how did she know? And what if I lied to her about any of the risk factors? Again, she doesn't know for sure. So why was she hesitant to test me for HIV?

Part of my job as a counselor is to assess someone's risk before taking the HIV test. I can assure you that I will never refuse someone a test just because they look safe.

Appearances can be deceiving, you know.

Shameless blog plug: For global HIV/AIDS news and commentary, check out i see HIV. It's a great blog written by a brilliant blogger who is fighting the good fight in South Africa.


Capitol Hill 20210 said...

I honestly don't think a lot of people get tested for HIV and STDS - as well as HPV because I think they are too scared to know. Every year at my annual ob/gyn visit - I get it all ran regardless if I am in a relationship or not, because you just never know.

I will be happy when the HPV vaccine gets approved for the over 30 crowd.

Mme. Meow said...

Good for you, Lizzie (asserting yourself, facing scary things head on, etc.). And yay on completing the training!

Anonymous said...

you're kidding...they are talking about an HPV for over 30? that is great. which reminds me, I have always wondered why it is limited to girls in their teens? do you know? ~erika

lizzie said...

CH 20210--yes, that's true. a lot of people don't get tested b/c they are afraid. but it's important to be tested for these things. the sooner you know, the sooner you can get treatment if you're positive/have an STD.

madame meow--thanks. so glad the training is over and done with. :)

erika--actually, merck (the company who brought you gardasil) is currently doing research on whether the vaccine is effective for women over the age of 26. if they find that it's effective, i wouldn't be surprised if the FDA approve it right away.

the reason why they focused on young girls originally is because most sexually active women are exposed to HPV. they felt the vaccine would be most effective in those who had not yet been exposed to any strain of HPV (or had minimal exposure which means not very many sexual partners), so basically teens and women in their 20s.

BTW, there are tons of strains of HPV, some less virulent then others. if you're sexually active, chances are that you've been exposed to some strain of HPV.

Mad Cabbie said...

I think all STD should be a part of the annual physical exam Lizzie!

intellileg said...

Wow -- that was fast! Congrats on your new status as a qualified VCT counselor ;)

If only people wouldn't make assumptions about their partners... Clinicians (in their professional capacity) are unfortunately at the end of the usual causal chain. Anyone know someone capable of remixing the Michael Jackson song 'Black or White'?

aneo said...

Thanks :D