HIV Testing Blog

A former teacher from South Carolina has been charged with three counts first-degree criminal sexual conduct.  The judge also ordered the teacher, Joel L. Bedenbaugh, to register as a sex offender.

Bedenbaugh was sentenced to six years in prison for not telling his ex-wife, to whom he was married for five years, that he had HIV.  This exposed her to possible infection.  Instead, he told her that the medicine that he took was for a blood disease.  She remains uninfected.

It is illegal to knowingly engage in sexual intercourse with another person without first informing them of an HIV infection.

In 2006, Bedenbaugh was convicted for  inappropriate contact with a 13-year-old girl in November 2006.  More recently, in 2008, he was investigated for  an alleged sexual assault on a juvenile in 2008.  This brought about attention to his medical history, which indicated that he had HIV.

For the original article, please refer to original articles.

First time in local police history for charge under 1994 state law

A Clarksville woman was arrested Thursday.  She was charged with knowingly exposing a man to HIV.

The woman, Donyel Da’Shawn Brown, was charged with criminal exposure to HIV, and her bond was set at $1 million.

The arrest warrant states a man reported Brown knowingly had unprotected sex with him for four years without telling him she was infected.

Also, Brown and the man had a child during the time she was diagnosed with HIV, the warrant said, but has not been determined if the child has HIV. Whether the child and man were infected has not been determined, Knoll said.

The state law, which took effect in 1994, does not require “the actual transmission of HIV” for someone to be convicted. Brown can be acquitted if she can prove that her partner had prior knowledge of her HIV status.

If convicted, Brown could face jail time of three to six years.

For the complete article, please refer to www.hivtestingblog.com/original-articles/

The human immunodeficiency virus (HIV) is a retrovirus that causes acquired immune deficiency syndrome (AIDS). HIV can be transmitted through the exchanging of bodily fluids including blood, semen, vaginal discharge, and breast milk. Means of transmission include sexual contact with an infected person, sharing of needles or syringes with an infected person, or through blood transfusions with infected blood. Low quantities of HIV has been found in the saliva and tears of some AIDS patients; however, contact with saliva or tears has never resulted in an HIV transmission.

Healthcare workers are often exposed to the virus at work; however, it is unlikely that they will contract the virus from a patient. Since December 2001, there have been only 57 documented reports of patient-to-worker HIV transmission, mainly due to precautionary guidelines that healthcare workers follow. The main risk of transmission for healthcare workers  is through accidental needle sticks or other injury with a contaminated instrument. However, even here the risk is small. “Researchers estimate that only about 0.0-1% or healthcare workers” contract HIV from an accidental needle stick.

This low statistic can be attributed to post-exposure prophylaxis (PEP), which can be taken immediately after exposure to reduce the risk of transmission. PEP uses antiretroviral therapy (ART) to prevent transmission, but often comes with serious side effects including dizziness, fatigue, nausea, vomiting, diarrhea and more. Current antiretroviral drugs cannot cure HIV infection, nor reduce the risk of transmitting it to someone else, but they can suppress the virus to undetectable levels in some cases. It has been estimated that PEP reduces the infection rate among healthcare workers by 79%.

Post-exposure Prophylaxis should begin immediately after the exposure, seeing as how PEP is most effective when it is initiated within two t0 four hours of exposure. The specific dosage of medication depends on a couple factors including the patient’s overall health, the severity of exposure, the availability of antiretrovirals, and if the patient has any known or possible cross-resistance to any drugs. Treatment normally lasts no less than two weeks and no longer than four. Studies show that almost a quarter of those receiving PEP stop taking the medications early because of side effects. As with all forms of treatment, it is less effective if it ends early.

HIV tests should be performed after any risky sexual behavior, even if PEP was used. Immediately after HIV enters the body antibodies are produced to fight off the infection. While these antibodies cannot completely eliminate the virus, we can use their presence to see if HIV is in the blood. Most people develop detectable antibodies within two to eight weeks; however, it may take longer in some people. Most often, the enzyme immunoassay (EIA) test is used to detect HIV antibodies. If a positive result is returned it is confirmed with a follow-up test before making a diagnosis. Typically the Western blot test is used to confirm a positive HIV result. Other testing options include DNA or RNA tests, which instead of looking for antibodies actually look for genetic material of HIV. These tests can be used for early detection of HIV.

With the combination of healthcare precautions and treatment options such as PEP, we have the ability to decrease the number of patient to worker HIV transmissions drastically.

*For the complete article please refer to http://hivtestingblog.com/original-articles/

MAJOR RECOMMENDATIONS

Responsibilities of Child Healthcare Providers

As part of the initial newborn evaluation, the pediatric clinician should determine whether human immunodeficiency virus (HIV) testing of the mother has been completed properly and should follow up on any outstanding laboratory values.

Pediatric clinicians should obtain testing for HIV beyond the neonatal period if the child presents with signs and symptoms of HIV disease. Testing should be performed in children who have not yet been tested when risk factors for HIV infection exist in the child or one of his/her parents.

Laboratory Tests for HIV in Newborns, Children, and Adolescents

Because positive antibody results alone do not establish infection in children younger than 18 months of age, assays to detect virus (HIV deoxyribonucleic acid [DNA] polymerase chain reaction [PCR] or viral culture) should be used for diagnosis (see Figure 1 in the original guideline document).

In children older than 18 months of age, HIV infection may be diagnosed on the basis of a positive HIV antibody test (enzyme-linked immunosorbent assay [ELISA]) and a confirmatory test, such as Western blot.

Because of the time period between infection and the development of detectable antibodies, children/adolescents exposed via sexual activity, sexual abuse/assault, or infected blood who have an initial negative test result should be retested at 1 month, 3 months, and 6 months after exposure.

Because a child with end-stage HIV disease may become HIV-antibody seronegative as a result of severe humoral immunodeficiency, children who are clinically suspected to be HIV-infected yet test HIV antibody negative should be tested by DNA PCR (or HIV culture).

Children older than 18 months of age with an indeterminate Western blot result should be retested as soon as possible. If the Western blot result remains indeterminate, the patient should be tested for HIV-2 or specific viral tests (e.g., DNA PCR) for HIV-1 should be performed.

Rapid testing and expedited preliminary test results prior to Western blot confirmation should generally be used only when immediate information is needed to determine the need for post-exposure prophylaxis in the labor/delivery, newborn, or other acute exposure settings, or when the person who is being tested is unlikely to return for a follow-up visit.

When preliminary diagnostic tests are used for expedited HIV testing, a preliminary positive test result must be confirmed with a Western blot as soon as possible.

Testing for HIV Antibody

See the original guideline document for discussions of screening tests, confirmatory testing of positive results, and rapid test assays.

Testing for HIV or Viral Components

Clinicians should test children younger than 18 months of age who are born to an HIV-infected mother for HIV using one of the following methods:

* HIV DNA PCR (preferred method)

* HIV culture (acceptable method)

Because infection can only be confirmed with two positive test results performed on samples collected at different times, a repeat sample should be obtained promptly for any child with a single positive test result.

In an infant younger than 18 months of age, HIV can be reasonably excluded with two negative HIV viral tests, one at 1 month of age or older, and the other at age 4 months or older.

Ideally, a DNA PCR should be obtained for HIV-exposed infants at each of the following time points:

* at birth

* at 2 weeks of age

* at 4 to 6 weeks of age

* at 6 to 12 weeks of age

* at 4 to 6 months of age

See the original guideline for discussions of HIV DNA PCR, HIV culture, plasma HIV RNA, and HIV antigen detection.

HIV Counseling and Testing

In New York State, written informed consent from the child’s biological parent or legal guardian must be obtained before HIV testing can be performed in children except in certain specific circumstances, such as expedited testing, newborn screening, and follow-up PCR testing, and when testing is urgently necessary to provide medical care for a life-threatening condition.

When HIV testing of a child is performed, the parents should be considered for testing as well.

If a child is found to be perinatally HIV infected, his/her siblings also should be tested.

If HIV infection is newly diagnosed in a woman, all of her children should be strongly considered for testing, even if they are asymptomatic.

Pre-Test Counseling

The clinician should counsel the child’s parent or guardian or the child/adolescent with capacity to consent prior to HIV testing (see Table 2 in the original guideline document).

In New York State, a minor’s right to consent for or refuse HIV testing is based on his/her capacity to understand, without regard to chronological age, what an HIV antibody test actually tests for, the implications/consequences of being HIV infected, and why he/she is at risk for HIV.

The clinician should arrange for follow-up visits at the time of testing and should note in the patient’s medical record that counseling was provided and written consent was obtained when required.

When rapid testing is obtained and will yield a preliminary result during the visit, the clinician should first ensure that the patient/parent is emotionally able to receive a positive result and that mental health services are available for patients receiving a positive result.

Obtaining Consent

See the original guideline document for a discussion New York State laws on obtaining consent for HIV testing in children and adolescents for HIV testing.

Post-test Counseling

Counseling after a Patient Receives a Positive Test Result

Positive HIV test results should be presented in person to the appropriate individual (patient, parent, or guardian). A clinician should not communicate results to a patient or family member by telephone or mail.

Clinicians must respect an adolescent’s right to confidentiality concerning HIV status.

The clinician should explain the test results and should provide general information about available treatment.

The clinician should discuss the implications of the HIV Reporting/Partner Notification law (refer to the section “HIV Reporting and Partner Notification” below).

The clinician should provide or arrange for necessary referrals for treatment and supportive services.

The clinician should discuss methods of risk reduction and advise the family to inform medical personnel of the child’s HIV status during any medical care visit.

Counseling After the Patient Receives a Negative Test Result

When telling a patient that his/her test result is negative, the clinician should educate the patient on how to reduce the risk of transmission in the future.

HIV Reporting and Partner Notification

Since June 2000, New York State has required HIV reporting and partner notification for all confirmed positive HIV tests (unless testing occurred at an anonymous site) and HIV-related tests.

During pre-test counseling, parents/children should be informed that if their HIV test result is positive, their names will be reported to the New York State Department of Health.

Parents/children should be informed during pre-test counseling that if they provide the names of sexual or needle-sharing partners, the provider is required to report these names to the State Health Department. They should also be informed that if the test results are positive, their partners will be notified that they have been exposed to HIV.

All sexually active HIV-infected adolescents should be informed about the importance and benefits of notifying partners of their possible exposure to HIV.

Adolescents who are undergoing HIV testing should be questioned regarding the potential for domestic violence if their partners were notified. If domestic violence is a concern, partner notification should be deferred until the risk of harm to the patient (or one close to the patient, e.g., child) is eliminated.

HIV Testing of Older Children and Adolescents With the Capacity to Consent

Clinicians should be knowledgeable about New York State laws pertaining to adolescent consent and confidentiality and should educate their patients about these laws (see the National Guideline Clearinghouse (NGC) summary of the New State Department of Health guideline Identification and Ambulatory Care of HIV-exposed and -infected Adolescents).

In New York State, older children and adolescents who are judged capable of understanding the informed consent process may give written informed consent for HIV testing.

Parents cannot be informed of their child’s HIV test results without the explicit consent of the child or adolescent who is deemed capable of providing consent.

Ideally, HIV testing of older children and adolescents should occur in a comprehensive care setting that provides social support, ancillary services, and ongoing health care.

HIV Testing in Children in Foster Care

Within 5 days of entering the foster care system, all children must be assessed for capacity to consent for HIV testing. If a child is determined not to have capacity to consent, an HIV risk assessment must also be completed within the first 5 days of entering foster care. Children already in foster care must be assessed for HIV risk factors at least 60 days prior to their next scheduled periodic medical examination. If it is determined that a child may have the capacity to consent, an assessment of capacity to consent must be made and documented by authorized foster care agency staff within 30 days of the child’s entry into foster care. An HIV risk assessment must also be completed within this timeframe.

If one or more risk factors are present, a child in foster care should be offered HIV testing, or if the child lacks capacity to consent, he/she should be tested for HIV infection.

Adolescents and older children in foster care with the capacity to consent for HIV testing have the right to either consent for their own test or refuse testing.

For the commplete article, please refer to http://www.guidelines.gov/summary/summary.aspx?doc_id=6834

If you are worried about HIV it might be because you don’t know how risky your sexual behavior is, you have specific questions about something you’ve done recently, or you are anxious about something you’re interested in trying in the future.

It’s important to have clear information about HIV transmission and prevention. Arming yourself with this information may help diminish your anxiety, because then you will know exactly how HIV is transmitted and how it isn’t.

Get tested!

Knowing your HIV status is very important. If you test negative, you can take steps to remain negative by educating yourself about HIV. If you test positive, you can take steps to prevent the spread of the virus to your partner(s). Knowing your status also means that you will be able to make critical and timely decisions about your treatment and care and get support to help deal with all the feelings you may have about knowing your status.

About My Health offers confidential HIV, Hepatitis C, and Syphilis testing. To find a local testing center across the United States, call their hotline at 1.866.926.4669.

Babies who were born with HIV/AIDS in the 1980s have defied initial expectations. No one expected them to live long.

Since the mid-1990s in developed countries, antiretroviral drugs have largely prevented mothers from transmitting HIV/AIDS to their babies.

Nearly 30 young adults and teenagers who were born with HIV/AIDS meet every week at the Jackson Memorial Hospital in Miami, Florida. “We don’t want to talk about HIV every day,” said Eric Koumbou, 19. “If you talk about HIV and you don’t have it and I do, sometimes it makes me angry or makes me sad.”

For the complete article, please see http://www.cnn.com/2009/HEALTH/06/22/hiv.children.generation/index.html?eref=ib_topstories.

The Adult Industry Medical Healthcare Foundation, reacting to a case disclosed last week, says it’s increasing database controls and urging producers to not accept paper test results from performers.

In an effort to prevent the possible spread of HIV in the adult film industry, the San Fernando Valley-based health clinic that serves the porn industry said Monday it is stepping up controls in its online database and urging producers not to accept paper copies of test results.

For the complete article, please refer to http://www.latimes.com/features/health/la-me-porn-hiv16-2009jun16,0,2659497.story.

Mothers2Mothers program aims to prevent AIDS virus transmission to infants.

At the World Economic Forum on Africa, the impact of HIV/AIDS on African countries is being addressed. The forum has honored one program that helps prevent mother-to-child transmission and turns stigmatized women into role models.

By giving the Mothers2Mothers program the Schwab Award, Falk says the World Economic Forum recognizes its success as a socially conscious business – combining the best of the private and public sectors.

For the complete article, see http://www.voanews.com/english/Africa/2009-06-11-voa18.cfm.

Schistosomiasis is a worm disease that primarily exists within rural Africa. The worms typically infect humans who are swimming or washing in snail-infested waters by leaving the snails and burrowing into the skin. The disease starts as a urinary tract infection, but if left untreated it can lead to genital sores. These sores provide an entrance for HIV during sexual intercourse; therefore, increasing the rates of transmission.

Thankfully there is an easy way to reduce the cases of Schistosomiasis. For only 32 cents a child can be treated with the drug praziquantel, which kills the worms and prevents any further infection. A pilot program was performed in Burkina Faso and it suggested that for $22 million we could treat all 70 million children who are infected, and carrying the plan out for a decade would cost only $112 million.

For a relatively low cost the HIV/AIDS epidemic can be significantly reduced in one of the most affected areas… there is no reason not to do it.

* For the complete article, please visit http://hivtestingblog.com/original-articles/