The Michigan AIDS Fund released its first ever report card on HIV work last Thursday. While the over all grades for the state are average, B- in care and treatment, B- in funding, C in HIV prevention and a C in public policy, the details of each area raise concerns.
“Considerable time, energy and resources have been invested by individuals, government agencies and nonprofit organizations to achieve the successes outlined in this report card,” the AIDS Fund executive summary reads. “Yet, the crisis expands, requiring still greater effort to address the shortcomings also identified here.”
The report details show the state has failed in such key prevention areas as men who have sex with men, African Americans and youth ages 13-24, as well as failed to make HIV testing routine in medical settings. The Centers for Disease Control changed testing recommendations in September of 2006, from testing of those in high risk groups, to part of a routine medical screening for everyone. The state has not implemented that recommendation.
Debra Szwejda, acting director of the division of health, wellness and disease control for the Michigan Department of Community Health, said the state supports making HIV testing routine in medical facilities, but the state is unwilling to lobby for a repeal of a law requiring signed consent for all HIV testing in the state. “We feel this can be implemented successfully in the state without changing the law.”
The 2006 CDC report noted informed consent and mandatory pre and post-test counseling were barriers to implementation of routine HIV testing. The report said removal of those requirements and creation of an opt-out testing option would make testing less burdensome to doctors, who told the CDC that they did not have time to do the required counseling.
And while Szwejda said the state won’t eliminate the law because opt-out testing is not really an option in Michigan, the facts show a very different reality. The AIDS Fund report gives the state an A in preventing transmission of the virus from mother to child during pregnancy. This positive outcome is the result of opt-out testing for all pregnant women in Michigan. Opt-out testing means a person signs a blanket authorization for testing which provides consent for HIV testing as well. In order to not be tested, a person must specifically decline to be tested for HIV.
Workers in HIV/AIDS service organizations said there are still numerous obstacles to getting tested for HIV.
Kaye McDuffie, early intervention coordinator for the Lansing Area AIDS Network, said there are many issues which serve as barriers to people getting tested. She cited the location of testing centers, hours the centers are open and people not perceiving themselves at risk for infection as just some of the barriers. But at the top of the list, she said, is stigma around the virus.
“There is still a lot of fear and prejudice and discrimination,” McDuffie said. “People have actually made an assessment of their community or family support system and they have determined that no one would be there for them if they had HIV disease. So, without a diagnosis, they are able to maintain a fragile support system.”
An informal survey of men talking in the gay chat rooms on gay.com found similar issues.
“I dont have HIV and I am not going to get it, period,” said a 43-year-old bisexual from Garden City. “End of discussion.”
“I don’t get tested because I quit having sex, case closed,” said a 23-year-old from Lansing.
A 28-year-old from Ypsilanti said that he is nervous about getting tested for HIV in part because he is afraid of being positive and in part because he is afraid of how his partner will respond. “It’s also a fear. If you do have it, what happens next? There is no real answer thereafter of how you deal with what comes up if you are positive. That is also something I never usually think about, but does affect my decision.”
Others in the informal survey said they got tested every six months because it was the right thing to do, and another person said he did not get tested because he has been HIV positive since 1989.
McDuffie said one of the other barriers to testing she has seen working at LAAN is what she labeled the “backlash” of the success of HIV treatments. “One of the drawbacks (of the new drugs) especially among young people is that they think it is no big deal (to test HIV positive),” she said.
Another barrier to getting tested that Jihannh Jones, program coordinator for the Midwest AIDS Prevention Project brought out, was a fear of legal obligations if a person tests positive. Under Michigan law, it is a felony to know that you are HIV positive and engage in any sexual conduct without informing a partner before hand. “Some clients don’t want to be held accountable,” Jones said.
Jay Kaplan, staff attorney for the ACLU of Michigan’s LBGT project, said the HIV disclosure law needed to be revisited. “This was a law uniquely designed in the late 80s to address AIDS. There was a lot of fear about the way the virus was transmitted, which may be why it is overly broad,” he said. The law was used, Kaplan said, to prosecute a gay man who engaged in mutual masterbation. The law defines any sexual act, regardless of protection such as a condom, as a potential violation of the law. Under the law, using a sex toy on another person and not informing that person of HIV status could lead to a felony prosecution.
Szwedja said it was the first time she had heard the HIV felony law was a barrier to testing, but said she would discuss the issue with others. She declined to discuss the issue further.
McDuffie said the state must do more to address the stigma issues around HIV. “General education to reduce some of the stigma is a key barrier we need to confront to make testing acceptable.”
Jones said the African American community has to step up to the plate. “I feel like churches need to talk about it. You never hear them talking about getting tested for HIV, but (you) hear them talking about diabetes or heart disease. Everytime they have health fairs its diabetes screening, cholersterol screening and heart disease screening– but no HIV testing.”
Szwedja said the state is doing what it can, but agrees more could be done. She points to a new grant from the CDC and distributed in Wayne county to increase HIV testing in the African American community.
She said, however, that the state is working with limited resources. “We have media, social marketing campaigns, peer models and other methodologies working out there,” She said. “We have to work with what we have.”
As the state’s budget crisis has worsened, Szwedja said, the money for HIV programs has decreased. “We have to do more with less. If I had the resources I would expand testing.”
And while the cutbacks have lead to staffing reductions, she said the moves are not putting Michigan at any greater risk for HIV infections. “It makes us work harder and smarter on addressing HIV in our community. I would certainly love to have more, but I don’t see that in the near future,” she added.