Thousands might not know they carry the HIV virus
Up to 4,500 people in B.C. are carrying the HIV virus unawares — and spreading it, health officials believe.
“Of all people who have HIV, probably about a quarter don’t know it,” says Dr. Reka Gustafson, a medical health officer for the Vancouver Coastal Health region. “One of the main reasons for that is we don’t test for HIV as much as we should. There are very few screening tests that have such a great potential for benefit, both for the individual and for their community.
“We haven’t really incorporated HIV testing into the medical care that people are already receiving. We’re missing too many opportunities to recommend tests to people. It isn’t that people are avoiding HIV testing. It just doesn’t cross their mind.”
Official estimates of the number of unwitting HIV carriers range from 2,500 to 4,500. More than half of new HIV infections in B.C. are transmitted by people who don’t know they carry the virus, Gustafson says.
Six months ago, St. Paul’s hospital staff began suggesting to all patients, regardless of age or condition, that they receive an HIV test. So far, 10 people who hadn’t known they were infected have tested positive, says Miriam Stewart, a St. Paul’s program director.
Now, as part of a pilot project also involving family doctors, walk-in clinics and mental-health facilities, the hospital’s emergency department is taking a further step to identify HIV victims. “Point of care” tests will soon be offered in the department, providing results in about a minute.
“It’s a big deal in an emergency department, because that’s a department that sees a lot of people,” Gustafson says.
Adding to the benefit for patients is the position of St. Paul’s as an international leader in HIV/AIDS research and treatment. “If you get that diagnosis,” Gustafson says, “the thing you need right away is people that can provide excellent care.”
Untreated, HIV infection leads to what doctors used to call AIDS, but is now often referred to as “advanced HIV disease” because the symptoms and their effects are so variable. The virus cripples the immune system and causes an inflammatory response. Those carrying the virus may suffer brain damage, cardiovascular disease, cancer and “opportunistic infections” by other bacteria and other viruses, and will usually die if not treated, Gustafson says.
Identifying infected people helps stop the spread of the disease, and allows victims to start receiving treatment.
“Treatment actually has a profound effect on both how long people live, but also whether they transmit it,” Gustafson says, adding that the anti-HIV drug regime is much more effective when patients start it relatively soon after infection.
St. Paul’s emergency serves the Downtown Eastside, and although drug-addicted slum-dwellers face a high HIV risk, needle-using addicts make up only 18 per cent of B.C.’s HIV-infected, Gustafson says. Gay men, at 45 per cent, make up the largest group of HIV victims. Heterosexuals come next at 27 per cent.
The new protocol of recommending HIV tests to all patients has also been implemented at Mount St. Joseph Hospital and Vancouver General Hospital. At all three facilities, 92 per cent of patients asked agree to have a test, Gustafson says. “It’s important that people can say ‘No,’” she says. “Few do.”
HIV testing should be “part of preventive health care for everybody,” Gustafson says. “Any sexually active person should get tested.”
Pharmaceutical advances mean that some HIV patients need take only one pill a day, Gustafson says, adding that people receiving effective treatment are 96 per cent less infectious than those untreated.
“If you’re HIV-positive today and you know it and you are treated, you can live to a nearly normal life span,” Gustafson says. “You can have relationships, you can have jobs, you can have children.
“Humans are sexual beings and an HIV diagnosis doesn’t mean the end of that.”