Universal testing for HIV can do more harm than good

The idea of early detection and cure is appealing. But if the test is unreliable, and the treatment itself harmful, universal testing can do more harm than good.

The availability of highly active antiretroviral treatment (HAART) for AIDS is leading to calls for universal testing for human immunodeficiency virus (HIV), which can progress to AIDS, and for early use of this expensive drug cocktail.

While HIV testing is said to be highly reliable, Professor Henry Bauer points out that in a population at low risk for AIDS, a positive test is nonetheless quite likely to be a false positive. Moreover, many people with genuinely positive tests never get AIDS.

The number of "long-term nonprogressors" is not known, but in an article (http://www.jpands.org/vol15no2/bauer.pdf) in the summer issue of the Journal of American Physicians and Surgeons, Bauer calculates that more than half of those tagged as "HIV positive" in a universal testing program could be either false positives or long-term nonprogressors.

Being pregnant, or simply being black, is a risk factor for a false positive HIV test. Tests are calibrated the same for Africans as for Europeans, although blacks are likely to have "sticky serum" that reacts somewhat differently. Thus, HIV tests are racially biased. It is incorrect to assume that black men are more promiscuous, or more likely to be bisexual, just because they are more likely to be HIV positive, Bauer states.

The HAART regimen is so toxic that 40 percent of prescriptions are not filled. Side effects include heart, liver, and nerve damage.

A positive HIV test can also destroy a person's marriage, employability, insurability, and peace of mind. These tests should be used only where indicated, rather than as screening tools, and only with fully informed consent, Bauer states.

"Disproportionate harm from aggressive testing and treatment will be experienced by pregnant women and persons of black African ancestry," he emphasizes.