It's about twenty years too late, but its about time that policymaker have begun to treat HIV/AIDS as a public health issue, rather than sweeping it under the carpet as a disease of the moral underclass.
The Centers for Disease Control and Prevention, with the support of the American Medical Association, is planning to release new guidelines calling for HIV testing to become part of standard medical checkups. Even the Vatican seems to be reexamining its long held position against the use of condoms to prevent HIV transmission.
The logic here is that 25% of people with HIV in the U.S. do not know they have it, and they account for a vast majority of the new transmissions of the disease. That proportion is probably even higher in third-world countries that a Vatican change in policy would target.
Unlike many other dangerous communicable diseases, HIV is actually a very difficult disease to transmit. It really requires direct transfer of bodily fluid into the bloodstream of the recipient. A vast majority of transmissions involve semen transfer through the small tears that occur during sex. Most of the rest are the result of intravenous drug use. Blood transfusions have not been a widespread issue in the industrialized nations since widespread testing began back in the 80s. A tiny minority result from accidental transmission during medical care.
Stopping any of these transmission methods is trivially easy. Condom use is highly effective at reducing transmission of HIV, and more dangerous sexual practices, such as anal sex, can be avoided altogether. Intravenous drug users can avoid sharing needles. Extra care can be taken during medical procedures if a patient or doctor is known to have HIV. (All documented medical transmissions have been avoidable, at least in hindsight — e.g. dentist not wearing gloves or nurse accidentally sticking herself with a used needle.) Sure, all of these practices are advisable even when people do not know they, or the other person, has HIV. But that's not really human nature. For example, most people would say they use condoms to avoid catching HIV. Few reflect upon the possibility that they might have HIV and that they should use the condom to avoid spreading it. A vast majority of people, if diagnosed with HIV, would be much more responsible about condom use, not sharing needles or whatever.
Considering how easily the transmission cycle can be cut off, the accuracy of testing methods and the cost in health care dollars and, most importantly, lives associated with the HIV epidemic, I believe that if HIV was non-sexually transmitted, routine testing would have been incorporated as part of standard medical care twenty years ago. If will even go a step further and say that if HIV had originally been seen as a heterosexual disease, and not solely as the domain of homosexuals and drug abusers, that we would have seen routine testing twenty years ago.
I do not buy the argument that it is the difficulty of providing the necessary counseling that has delayed inclusion of HIV tests in routine medical care. That argument is logically fallacious: "It is more important to provide sufficient counseling during the HIV testing process than it is to halt the spread of this disease. This is true regardless of the fact that there is no other disease that we believe requires this type of counseling, even though many diseases are deadlier."
At least the Catholic Church has been explicit that their policy that contributes to this disease is based on the moral question of how this disease is spread. I believe their policy is wrong, but at least they are up front about how they arrived at it.
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