America Living With AIDS

AM E R I C A Living With AIDS

The growing chorus of demands for
mandatory, widespread HIV antibody
testing of health care workers (HCWs)
and patients threatens to drive a
wedge between patients and their
caregivers. It also misses the point. As
the Centers for Disease Control
(CDC) has stated,
Mandatory testing of HCWs for
HIV antibody, HBsAg, or
HBeAg is not recommended.
The current assessment of the
risk that infected HCWs will
transmit HIV or HBV to
patients during exposure-prone
procedures does not support the
diversion of resources that
would be required to implement
mandatory testing programs.
Compliance by HCWs with recommendations can be increased
through education, training, and
appropriate confidentiality safeguards.
Mass screening programs would interfere with the doctor-patient relationship, would encourage a false sense of
security because of the time between
when infection develops and the time
when it can be measured by clinical
tests, and would imply a significant
risk of infection transmission in
health care settings when such risk is
actually very small, particularly, as
CDC has stated, "when HCWs adhere
to recommended infection control
procedures."

(Li RI tR A 5 PR I j) IDD
In most cities the care of HIV disease
is concentrated in a few hospitals,
often in public facilities or teaching
hospitals. Many of these hospitals
have centralized AIDS care or established AIDS-dedicated units. Hospitals and oupatient care should be
linked to community-based services to
ensure the continuum of services
identified above.
HIV-related services must be
expanded to include facilities where
underserved populations already
receive health care and human services, such as community health centers, migrant health centers, Indian
Health Service programs, and the like.
In addition, counseling, testing, and
care related to HIV disease must be
made available in settings where
providers speak the language of the
communities they serve.
Ongoing research is needed to
determine what works best where and
how to deliver care to people living
with HIV disease. Lessons can be
learned from the organization of care
for diseases other than HIV. For
example, in the context of hemophilia
treatment, a system of regional comprehensive treatment centers provides
both increased quality and cost-effectiveness by combining sufficient numbers of patients so that economies of
scale can justify the single-center multidisciplinary team approach. The
AIDS program of the Department of
Veterans Affairs, administered by its
Veterans Health Administration, has
become the largest single source of

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