Tuesday 22 May 2012

Most patients say 'no' to HIV test

TTSH study finds 8 in 10 refuse screening offered
By POON CHIAN HUI, The Straits Times, 21 May 2012

PUBLIC hospitals, since 2008, offer routine screening for HIV, but their patients do not seem to want it.

A recent study by Tan Tock Seng Hospital (TTSH) found that eight in 10 inpatients refused to get tested for the immunodeficiency virus that causes Aids.

The top reasons they gave were that they were unlikely to be infected because they were old, they feared needles, and they could not afford it.

While not surprising, this reluctance signalled an obvious stigma of the disease, said Dr Arlene Chua, an infectious diseases specialist at TTSH who led the study published in scientific journal PLoS ONE last month.

The study polled all inpatients aged 21 and older admitted to TTSH between 2009 and 2010 who qualified for the test - that is, they could not be in intensive care, have mental illness, be already HIV-positive, or have been tested in the last six months.

Some 79 per cent of the 41,543 patients eligible said 'no' to the test. Of the 21 per cent who said 'yes', 16 people were discovered to be HIV-positive.

HIV is contracted through sexual contact or infected blood.

Among those who opted out of the HIV screening, 55.8 per cent said they did not think they were at risk of the infection.

One in five said they feared needles while about 10 per cent said they have financial problems. The test would have cost them $6 to $10, after a subsidy.

Other reasons for declining included 'family objection' and 'fear of results'. In the study, patients could pick more than one reason.

Response has been lukewarm at the other public hospitals as well - in 2009, about 80 per cent of inpatients polled rejected screening.

Though the study showed that those who said 'no' believed they were safe from the infection - either because they were old or did not have sex - the data so far has suggested otherwise.

In the past decade, 30 per cent of new cases were aged 50 and above, the Health Ministry said.

To encourage more people to get screened, researchers suggested that awareness campaigns, which tend to target younger people, be also tailored to the elderly.

Early detection is still the key to bringing HIV infections down, said Dr Chua. 'Even if we drop the prices, you cannot access the treatment if you are not tested and diagnosed,' she said.

In Singapore, HIV has been slowly declining. In 2010, a total of 441 Singapore residents were reported to have HIV infections, a 4.8 per cent drop from 2009. But more than half was found during a late stage of the infection.

There were 195 new cases in the first half of last year.

Researchers also suggested the use of saliva tests for those afraid of needles.

Action for Aids president Roy Chan added that people should be made aware of the availability of affordable treatment that is also confidential.

'It is important to understand that the majority of Singaporeans have a negative view of HIV infection and treatment,' he said.

People with HIV take anti-retroviral drugs - which cost about $300 a month - regularly to stem the spread of infection.

The Ministry of Health is deciding if it should subsidise HIV drugs further by including them on the standard drugs list.

Professor Chan said: 'Much more must be done to de-stigmatise the disease and provide access to affordable, effective medications if we are serious in wanting to encourage more widespread testing, whether in hospital patients or the wider community.'

Say 'yes' to HIV test
Editorial, The Straits Times, 27 May 2012

It is disappointing to note that although public hospitals have offered routine HIV screening since 2008, most patients do not want it. A study by Tan Tock Seng Hospital (TTSH) carried out between 2009 and 2010 found that eight in 10 inpatients refused to get tested for the human immunodeficiency virus (HIV) that causes Aids. HIV is contracted through sexual contact or infected blood, and there is always a chance, however slim, that a person could have been infected - perhaps through contaminated blood transfusions, especially when these have been carried out in another country, infected needles, or even through just one sexual partner who happens to be carrying the virus but does not know it. Patients should agree to the test, not just to have peace of mind but to also not infect others close to them if they are tested positive. The cost of the test is, after all, only $6 to $10 after a subsidy.

It is likely that many patients refuse to take the test because they fear knowing the result, even if they will not admit to it. Unlike in the West, many in Singapore still do not know that HIV can be managed by drugs, and that HIV patients on these drugs can lead full, normal lives as the infection will not develop into Aids. More significantly, the cost of the anti-retroviral drugs is about $300 a month when it used to be more than $1,000. Doctors in the past two years have negotiated with drug companies and brought the cost down, according to TTSH. There is not much the health authorities can do at the moment about the social stigma of Aids, which is still persistent and prevalent, but it can publicise more widely and regularly the fact that HIV can be contained and at a relatively affordable cost. This may just ease the fear of testing.

Also, health campaigns so far have targeted only the young. They should reach out to the old as well. According to the Health Ministry, 30 per cent of the new cases in the past decade involved those aged 50 and above.

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