Aug. 4--You might go in with a broken arm, but you'll leave knowing your HIV status.
Most people who visit the Barnes-Jewish Hospital emergency room will have the chance to get a confidential, fast and free test for the virus starting today.
The hospital is one of the first in the country to launch universal HIV testing in emergency rooms, in part because of St. Louis' high rates of sexually transmitted diseases. St. Louis Children's Hospital started the testing last week.
Making it easier to test as many people as possible marks the new global thinking in HIV/AIDS prevention and treatment. Sexually active people of any age, race and orientation are now known to be at risk. Heterosexual contact accounted for one-fourth of the new AIDS cases in this region last year.
Routine testing lessens the stigma of the sexually transmitted disease and identifies people who don't know they're infected, said Dr. Rob Poirier, Barnes-Jewish Hospital's chief of emergency medicine.
"We don't know the true incidence of HIV in St. Louis because we're not able to test everybody," Poirier said. "Hopefully, by doing it in (emergency rooms), we're catching patients that don't get regular care in clinics. We know if we catch HIV early, the quality of life for patients is often much improved."
The tests, which involve a finger stick to get a drop of blood, will be offered to any patient ages 15 to 64 who comes to the emergency room between 9 a.m. and 3 p.m. and gives verbal consent. Typically, patients with less serious health problems will be approached, not those who have been in serious car accidents or are experiencing chest pain. The testing is aimed at patients who use emergency rooms as a primary source of health care. Those patients are most at risk because they tend to be uninsured and don't get regular medical care, doctors said.
To get tested for HIV in the past, patients would have to sign written consent forms, get extensive pre- and post-test counseling and wait a day or two to get the results in a follow-up appointment.
Those barriers stopped many people from getting tested. About one in four adults who have HIV do not know they are infected, according to the Centers for Disease Control and Prevention.
The emergence of tests that give results within 20 minutes, as well as new treatments that allow people with HIV to lead healthy lives has helped with the transition to less formal testing.
Two years ago, the CDC changed its recommendations to promote universal testing in routine health care settings.
About 200 people were diagnosed with HIV in the St. Louis region in 2007. The area accounts for nearly half of all cases of HIV and AIDS in the state.
Because St. Louis has high rates of sexually transmitted diseases, including HIV, local hospitals were offered part of a $700,000 CDC grant to start testing in emergency rooms. About 15,000 tests are expected to be given each year in the St. Louis area.
St. Louis Children's Hospital started a similar program last week for teenagers 15 and up who visit the emergency room. Under Missouri law, teenagers do not need parental consent to get tested for sexually transmitted diseases. The teens are asked whether they want the test and are given the results in private.
"We find a lot of adolescents have fallen out of a steady care relationship with their primary physician," said Dr. Ericka Hayes, a director of the hospital's pediatric HIV clinic. "If we test them early, they can know their status and make sure they are decreasing the likelihood they are going to transmit their infection to others."
In the first four days of the program, four teenagers were tested and all were negative for HIV. Doctors plan to encourage any teens who test positive to discuss the results with their families.
Other emergency rooms using routine HIV testing include hospitals in Washington, Denver, Chicago and Oakland, Calif. The Illinois Department of Public Health funds rapid HIV testing training for doctors and hospitals but it is unclear which hospitals in the state use the testing in emergency rooms.
Patients who get tested are given information on HIV prevention and treatment. It can take three to six months after infection for a person to test positive, so patients at high risk are advised to get retested.
"There are some people that will say they really don't want to know if they're HIV positive or not," Poirier said. "A lot of times it's because they don't understand the disease. ... This is a disease like any other STD where there's treatment now."
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