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HIV testing/Screening be made part of Primary Prevention?
This analysis backs up research on behavioral interventions that lower HIV transmission. The aim of the analysis are to reinforce interdisciplinary research that develops, implements, and evaluates practically and theoretically based interventions intended to prevent HIV transmission. This knowledge needs to progress understanding of the interaction between psychological, behavioral, biological and social factors that influence the acquirement of HIV in our populations. The analysis supports research that acts as the base for an empirically-based public health policy plan to prevent several new HIV infections as possible. Similarly, ASPQ supports basic prevention and intervention research that tackle multiple levels factors that facilitate or obstruct lowering of HIV risk.
Immense progress have been made over the ancient times decade in behavioral research on how to assist people prevent contracting HIV infections (primary prevention) and how to reduce or alleviate unfavorable consequences among individuals who are infected with HIV disease. Within the primary prevention areas, research has revealed the efficiency of risk-reduction interventions undertaken with communities, couples, individuals, small groups, and at a social policy/structural level. Advances in HIV medical care have as well created vital new challenges and task for behavioral scientists in the area of HIV secondary prevention.
Time and again, people with HIV infection visit health-care settings like hospitals, sexually transmitted disease [STD] clinics and acute-care clinics, for years without getting a diagnosis however they are not tested for HIV. From 1980s, the HIV / AIDS epidemic demographic in the United States have changed; mounting proportions of infected people are aged 20 years, members of racial or ethnic minority populations, women,, and heterosexual men and women who regularly are unaware that they are at risk for HIV, people who live outside metropolitan areas . Therefore, the effectiveness decides on risk-based testing to identify HIV-infected victims' reduction. Prevention strategies that integrate universal HIV screening have been very much effective. For example, screening blood donors for HIV has almost got rid of transfusion-related HIV infection in the United States.
Occurrence of pediatric HIV / AIDS in the United States has gone down significantly from 1990s, CDC (2004)., when prevention strategies started to consist of precise recommendations for usual HIV testing of pregnant women . Parental rate of transmission can be lowered to 2% with universal screening of pregnant women in mixture with prophylactic administration of antiretroviral drugs, avoidance of breast feeding and planned cesarean delivery in case of indication, CDC (1999). These successes differ with a relative short of improvement in preventing sexual transmission of HIV, for which screening is infrequently done. Reduction on incidences of HIV realized in the early 1990s has leveled and could have reversed in some populations in current years.
From 1998, the estimated figure of new infections has maintained to be stable at approximately 40,000 annually. The Institute of Medicine (IOM) stressed on prevention services for HIV-infected victims and suggested policies for diagnosing HIV infections in advance to add to the number of HIV-infected victim who were having knowledge of their status and who received clinical and prevention services in 2001. Most people who have the knowledge of their HIV infections considerably decrease sexual behaviors that can pass on HIV once they are aware that they are infected Marks G, Crepaz N, Senterfitt JW, and Janssen RS. (2005). In a meta-analysis of conclusions involving eight studies, the occurrence of vaginal intercourse or unprotected anal with a partners who is not infected was on average 68% lower for HIV-infected persons who had the knowledge of their status as was compared to HIV-infected persons who did not have the knowledge of their status. To raise diagnosis of HIV infection, destigmatize the testing process, connect clinical care with prevention, and make sure an instant access to clinical care for people with lately recognized HIV infection, IOM and other health-care professionals with expertise have supported embracing of routine HIV testing in all health-care settings.
Routine prenatal HIV testing with rationalized counseling and approved procedures has amplified the figure of pregnant women tested considerably. Contrary, the figure of people at risk for HIV infection who are screened in acute-care settings maintains to be low, regardless of constant recommendations backing up routine risk-based testing in health-care settings. From the survey of 154 health-care providers in 10 hospital EDs, the report from the providers indicated that when caring for an average of 13 patients per week alleged to have STDs, however only 10% of these providers encouraged these patients to be tested for HIV even if they were in the EDs. An added 35% referred patients to secret HIV testing places in the community; conversely, such referrals have confirmed ineffective due to poor conformity by patients. Argument given for failure to offer HIV testing in the ED was made up of lack of established mechanisms to make sure of the follow-up (51%), lack of the guarantee considered as essential to offer counseling (45%), and belief that the process of testing was as well time-consuming (19%).
With the institution of HIV screening in specified hospitals and EDs, the patients who test positive in terms of percentage always have been more than that observed nationally at publicly funded STD clinics and HIV counseling and testing places serving people at high risk for HIV. Since patients hardly look for testing when screening was provided at these hospitals, HIV infections always were known in advance than they might otherwise have been. Targeted testing programs too have been put into practice in acute-care settings; almost two thirds of patients in these settings admit testing, but since risk prevention counseling and assessment are taking a lot of time, only a limited proportion of entitled patients can be tested. Targeted testing in terms of risk behaviors fails to indicate a considerable figure of people who are HIV infected, (Centers for Disease Control and Prevention (2009).
A considerable number of people, as well as victim with HIV infection, do not identify themselves to be at risk for HIV or do not reveal their risks. Routine HIV testing decreases the stigma related with testing that needs assessment of risk behaviors. Additional patients acknowledge recommended HIV testing when it is administered routinely to every person, with no risk assessment. In 1999, to raise the proportion of women tested for HIV, IOM recommended embracing a countrywide policy of universal HIV testing of pregnant women after patient notification as a routine constituent of prenatal care, not in need of clear written permission to be tested for HIV, doing away with needs for widespread pretest counseling as needed provision of basic information concerning HIV. Following this, studies have shown that these policies, as proposed by IOM and other professional organizations, indicates an ethical balance among public health goals, rights of individual and justice.
HIV screening rates are always higher at settings that offers prenatal and STD services using opt out screening than at opt-in programs, which call for pretest counseling and precise written consent. Pregnant women articulate less anxiety with opt-out HIV screening and do not find it hard to reject a test. In 2006, approximately 65% of adults from U.S. surveyed backed up that HIV testing should be approached the same way as screening for any other disease, exclusive of special procedures like a written consent from the patient in order to know their status to be known so that prevention or medication measures to be undertaken for the diagnosed. Adolescents aged 13 -- 19 years represent new cohorts of persons at risk, and prevention efforts need to be repeated for each succeeding generation of young persons. The 2005 Youth Risk Behavior Survey indicated that 47% of high school students reported that they had had sexual intercourse at least once, and 37% of sexually active students had not used a condom during their most recent act of sexual intercourse. More than half of all HIV infected adolescents are estimated not to have been tested and are unaware of their infection whereby if they could be tasted and known their status they could use prevention measures.
Among young men who are aged 18 -- 24 years have sex with men (MSM) surveyed between 2004 -- 2005 in the five cities of U.S. cities, the number of infected with HIV was 14%; 79% of these HIV-infected MSM did not know of their infection. The American Academy of Pediatrics suggests that clinicians get information from patients who are in adolescent concerning their sexual activity and enlighten them on how to prevent HIV infection. Evidence shows that adolescents are to the option of obtaining this information just from their health-care providers but from their parents, teachers, or friends nevertheless, less than half of clinicians offer such guidance. Health-care providers' recommendations as well contributed to decision of the adolescents to be tested. Considering HIV testing provided by 528 adolescents who had primary care providers, 58% cited recommendation for their providers as their reason for testing.
The lately suggestion of U.S. Preventive Services Task Force was that clinicians screen for HIV…[continue]
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