Alerted by the AJOB blog to an opinion article on HIV testing in the New England Journal of Medicine. The World Health Organization lists voluntary counseling and HIV testing (VCT) as a “crucial entry point into the care and treatment programmes” (WHO 2001). VCT is considered an integral part of HIV prevention or treatment program, as it “enables uninfected people to remain so and enable those infected with HIV to plan for the future and prevent HIV transmission to others” (ibid).

The argument in the NEJM article is whether the HIV/AIDS epidemic should be treated as a viral epidemic, subject to the control of standard public health measures, or as a social disease, one in which the social mores and dangers of stigmatism of the individual are of primary concern. Certainly, it would be easier, and perhaps more cost-effective, to monitor the disease in the US with standard notification of partners and track progression of the disease epidemiologically:

"Using the current CDC estimate of 40,000 new HIV infections per year, the potential to prevent half to two thirds of these infections, and the current average lifetime cost of care for a patient with HIV infection of $200,000,²⁹ more effective epidemic control would save between $4 billion and $5.4 billion per year. Widespread availability of condoms, syringe-exchange programs, public health notification of the partners of infected persons, and improvement of case management and monitoring systems would be unlikely to cost more than an additional $1 billion to $2 billion per year nationally — two to three times the current CDC funding for HIV prevention."

The authors argue that in an age of openness and multiple anti-retroviral drugs, that it's a travesty that 2/3 of those with newly identified HIV-positive serostatuses do not inform their partners. I agree with that assessment. However, the problem of partner notification is the question whether proclaiming one's status is considered as socially acceptable as the researchers. If it is socially acceptable, then HIV testing and prevention methods (condom distribution, decrease in number of partners, careful monitoring of existing viral load) is working. In that case, HIV might well be managed as a chronic disease. However, if it is not, then the stigma attached to HIV (and even to STI's in general)

The downside is that routine notification of partners may have an adverse effect on the utilization of health care services. Could knowing that one's partner would be notified translate into a lack of willingness to access health services?