Cree Gordon was living on the streets of Eugene when someone from the local HIV Alliance offered him $10 to take an HIV test.
He took the offer, getting his blood tested and waiting the standard two weeks for the results. During that time, Gordon didn’t think about what might happen, focusing on his $10 reward.
“When I found out I was positive, I went into shock,” said Gordon, now a 21-year-old University student. “My counselor bombarded me with information.”
As a former prostitute and gay man, he fit the agency’s profile of a person at high risk of being HIV-positive. But a new recommendation from federal officials issued earlier this week would expand testing efforts to make screening routine for many Americans.
The Centers for Disease Control and Prevention recommended people in their teens through age 64 be tested annually during doctor visits. It also suggested that testing no longer require special consent forms or prescreening counseling, such as Gordon received.
Although many local health officials said increased testing could be beneficial, some expressed concerns about the effects of reduced counseling.
Many people don’t find out they have HIV until they experience symptoms of illness and submit to testing, prompting the CDC to issue the new suggestions. The CDC estimated that one-fourth of the approximately one-million people in the U.S. who have HIV don’t know they are infected.
Oregon law currently requires pretest counseling for all screenings. Yet the CDC report states that pre-test counseling and written informed consent are not feasible in emergency rooms and other busy health care settings.
Paula Staight, director of health promotion at the University Health Center, said prescreening counseling includes questions about why people think they might be at risk and information about the need for a second test if the original test is positive.
“Pretest counseling may be a barrier,” she said.
Having someone fill out a consent form before having blood drawn can be a barrier, said Jim Mough, medical lab supervisor for the Health Center. He said individuals who may have some reservations about blood sampling may take that time to reconsider.
“The fewer barriers there are, the more likely they will get the test,” Mough said.
Tom Donohue, the founder and executive director of Who’s Positive, said his organization is concerned about the change in pretest counseling, but he sees a potential benefit from eliminating the step.
“Young adults don’t want to talk about their sexual history,” he said.
Gordon said he has a few concerns about the CDC recommendations.
“One of my concerns is that I don’t want the counseling part to get lost,” Gordon said. “How ready is the average health care provider to give a positive result?”
Gordon said a lot of people go into denial, become depressed or become suicidal when they learn they have HIV. Gordon’s counselor didn’t let him deny his status, he said.
“She made me admit it to myself,” he said. “She made me say, ‘I am HIV positive.’”
Sharon Chamberlain, director of programs and services for the HIV Alliance, shares some of Gordon’s concerns.
“Both pre and post-test counseling are very important,” she said.
Staff members at HIV Alliance spend time going to training sessions, making them better equipped to give a positive result than an emergency room doctor, Chamberlain said. She hopes more cooperation will exist between hospitals and organizations such as HIV Alliance.
“We need to work together for clients who are tested in emergency rooms, for example, to have the appropriate referrals,” she said.
Chamberlain said people should remember that HIV is a life-altering change. Although people infected with HIV are living longer, it’s very difficult to manage, she said.
“The medications really affect the quality of life of someone with HIV,” she said.
The Health Center is considering approaching state legislators when they reconvene in January about changing the Oregon counseling law to eliminate the requirements, Mough said. The hope is that people will refer themselves for testing.
All test results would come with counseling, he said.
Methods of testing vary. The Health Center offers an oral swab test, branded Orasure, which doesn’t require drawing blood.
“The swab is a lower-risk test,” Staight said. The swab remains in the patient’s mouth for three minutes, and there is no risk of spreading blood-borne pathogens.
Mough said current circumstances in the Health Center do not encourage use of the swab because of confidentiality concerns. However, with the Health Center’s remodel nearing completion, those issues are expected to be resolved and the swab will become common in HIV testing, he said.
Donahue said he looks forward to the day HIV tests are sold over-the-counter in stores such as Wal-Mart. He hopes that if testing becomes more routine, talking about HIV will become more common.
For Gordon, a positive test began a life of advocacy, volunteering and outreach. He said his life is not much different from any other person. He is healthy and does not require medication right now, he said.
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