Early HIV Detection

Abstract

This paper documents the changing need for early detection of HIV infection and proposes a role for community mental health centers (CMHCs). Ignorance of HIV infection status can result in greater risk of medical complications and denies the individual the opportunity to take the steps necessary to prolong life and prevent further transmission of the virus. Individuals who know they are infected can obtain good medical care, avoid infection, avoid becoming pregnant, behave responsibly, and plan their lives appropriately. Advances in specific therapeutics now make it important for infected individuals to know their HIV status well before becoming overtly ill. The social history, sexual history, drug use history, and physical and mental status of each client will provide important clues regarding infection status. Reluctance to refer for testing because of concerns about level of stress, liability, and confidentiality should be tempered by a policy of referring for testing whenever any indication of infection arises.

Until recently, there has not seemed to be a compelling need to know if clients are infected with HIV. Since no effective treatments were available for nonsymptomatic individuals, it was often thought that such knowledge could do more harm than good. Identification of HIV status can lead to discrimination, increased stress levels for clients and staff, and excessive concern about chart confidentiality. Many community mental health center (CMHC) directors have expressed concern that their center might incur financial obligation for medical treatment of infected clients in their facilities.¹ Some staff are concerned about their liability if they know that a client is HIV infected and they do not take steps to protect unaware spouses and lovers. Government agency administrators have occasionally expressed the logic that if HIV infection is identified, treatment must be provided. Since the government cannot afford to provide all the treatment that is needed, testing has only been ordered when symptoms make it absolutely necessary.

Mental health staff report great discomfort in working with HIV-infected clients.^2,3 One researcher⁴ reported that 55 percent of a sample of 499 CMHC treatment staff would prefer to avoid working with HIV-infected clients. Twenty-nine percent of those surveyed indicated that they would actually try to avoid working with infected clients.