Routine HIV Testing among Hospitalized Patients in Argentina. Is It Time for a Policy Change?

Abstract

IntroductionThe Argentinean AIDS Program estimates that 110,000 persons are living with HIV/AIDS in Argentina. Of those, approximately 40% are unaware of their status, and 30% are diagnosed in advanced stages of immunosuppression. Though studies show that universal HIV screening is cost-effective in settings with HIV prevalence greater than 0.1%, in Argentina, with the exception of antenatal care, HIV testing is always client-initiated.ObjectiveWe performed a pilot study to assess the acceptability of a universal HIV screening program among inpatients of an urban public hospital in Buenos Aires.MethodsOver a six-month period, all eligible adult patients admitted to the internal medicine ward were offered HIV testing. Demographics, uptake rates, reasons for refusal and new HIV diagnoses were analyzed.ResultsOf the 350 admissions during this period, 249 were eligible and subsequently enrolled. The enrolled population was relatively old compared to the general population, was balanced on gender, and did not report traditional high risk factors for HIV infection. Only 88 (39%) reported prior HIV testing. One hundred and ninety (76%) patients accepted HIV testing. In multivariable analysis only younger age (OR 1.02; 95%CI 1.003-1.05) was independently associated with test uptake. Three new HIV diagnoses were made (undiagnosed HIV prevalence: 1.58%); none belonged to a most-at-risk population.ConclusionsOur findings suggest that universal HIV screening in this setting is acceptable and potentially effective in identifying undiagnosed HIV-infected individuals. If confirmed in a larger study, our findings may inform changes in the Argentinean HIV testing policy.

Associations between the legal context of HIV, perceived social capital, and HIV antiretroviral adherence in North America

“…HIV-related prosecutions are cumulative estimates from the beginning of the epidemic in 1981 or when records of HIV-related prosecutions became available within a geographic location. In the United States this information was obtained from the Center for HIV Law and Policy [27] Positive Justice Project and in Canada, this information came from the Canadian HIV/AIDS Legal Network [26] and the work of Mykhalovskiy and Betteridge [15]. Further legal contextual information for both countries was obtained from United Nations General Assembly Special Session (UNGASS) on HIV/AIDS country reports [64] and the report Advancing HIV justice: A progress report on achievements and challenges in global advocacy against HIV criminalisation published by the Global Network of People Living with HIV (GNP+) and the HIV Justice Network [65].…”

“…The criminalization of HIV exposure/transmission and the risk of prosecution based on HIV status is a controversial structural challenge faced by many PLWH globally [14,26-28]. Criminalization of HIV exposure/transmission and prosecution for HIV exposure takes on many forms including enhancements (e.g., the application of additional or more severe criminal penalties) during sentencing for other crimes when HIV is a factor in the case; court decisions that consider HIV a “deadly weapon,” resulting in PLWH being prosecuted for spitting; and laws that criminalize potential HIV transmission, without evidence of intent [14,26-28]. These prosecutions occur even when there is evidence that the PLWH has an undetectable HIV viral load and practices safer sex by using a condom, rendering HIV transmission highly unlikely [14,26-28].…”

“…Criminalization of HIV exposure/transmission and prosecution for HIV exposure takes on many forms including enhancements (e.g., the application of additional or more severe criminal penalties) during sentencing for other crimes when HIV is a factor in the case; court decisions that consider HIV a “deadly weapon,” resulting in PLWH being prosecuted for spitting; and laws that criminalize potential HIV transmission, without evidence of intent [14,26-28]. These prosecutions occur even when there is evidence that the PLWH has an undetectable HIV viral load and practices safer sex by using a condom, rendering HIV transmission highly unlikely [14,26-28]. Multinational and non-governmental organizations have highlighted the challenges that the criminalization of HIV exposure/transmission pose for effective HIV prevention, care, treatment, and management [26,29].…”

“…These prosecutions occur even when there is evidence that the PLWH has an undetectable HIV viral load and practices safer sex by using a condom, rendering HIV transmission highly unlikely [14,26-28]. Multinational and non-governmental organizations have highlighted the challenges that the criminalization of HIV exposure/transmission pose for effective HIV prevention, care, treatment, and management [26,29]. Substantial evidence suggests that the criminalization of HIV exposure/transmission has limited benefit for population health and may adversely affect individual behavior [9-11,13,14,16].…”

“…Homophobia has been termed a weapon of sexism [46] and has been documented as a factor influencing the health and health outcomes of PLWH [47]. The criminalization of HIV and homophobia in Canada and the United States may adversely affect HIV prevention and treatment efforts among racial and sexual minority groups [9-12,14,15,26,48,49]. …”