HIV TESTING: A MATTER OF LIFE AND DEATH

Requests for testing for the virus that causes acquired immunodeficiency syndrome (AIDS) has increased annually for the last three years at two local centers that offer public screenings.

Annual increases at the Cape Girardeau County Public Health Center in the number of human immunodeficiency virus (HIV) tests administered reflects the public's growing understanding of the health threat, department administrator Charlotte Craig believes.

That can only be good news, she contends.

The screening involves before-and-after-test counseling and testing of a blood sample for the presence of HIV antibodies. HIV is the virus that causes AIDS. Education and availability account for the annual increases in individual requests for the HIV test, Craig said.

The Southeast Missouri State University Center for Health and Counseling follows the same testing procedures as the county health department, said Sallie Loos, assistant director of the center. Both are classified as confidential testing sites.

The confidential screening procedure begins with counseling and is followed by the simple drawing of a blood sample, with the entire procedure taking perhaps 20-30 minutes, explained Jane Wernsman, head nurse at the local health department.

"The blood specimen is sent with an identifying number to the Missouri Department of Public Health state lab in Jefferson City," she said. Test results are typically available in about two weeks.

"When the individual comes in, at the initial visit, we go ahead and give them a return date," Wernsman said.

At the return visit, "the individual and nurse meet confidentially," the head nurse explained. At that time, the results of the test are provided. Should the test return negative, counseling will include a review of the initial risk assessment, including discussion of ways to reduce the risk, Wernsman said.

If the test return shows that HIV antibodies are present in the body, the counseling covers a "whole host" of subjects, explained administrator Craig. The department also provides referral information covering a broad range of potential needs.

The HIV screening "simply tests for the presence or absence of the HIV antibody," said Wernsman. It does not indicate whether the individual has AIDS or whether the person will develop AIDS, she stressed.

When any virus enters the body, the immune system responds by producing proteins called antibodies, a Centers for Disease Control brochure available at the health department explains. When an HIV infection is present, the body responds by making HIV antibodies. Thus, the HIV-antibody test tells whether the person is infected with HIV.

Unlike other types of antibodies, HIV antibodies do not protect the body from the HIV virus. The antibodies "do not make you immune, and do not prevent you from giving HIV to someone else," explains the brochure, entitled "Voluntary HIV Counseling and Testing: Facts, Issues, and Answers."

If they are going to appear, HIV antibodies can typically be detected within three months from the time the virus enters the body. HIV can be in the blood, semen and vaginal fluids of infected people, and HIV-infected people can infect others, even if no symptoms are present, according to the Centers for Disease Control.

Should a person's test return negative, yet "the person is processing high risk behavior, we'll recommend periodic testing based upon their activities," Wernsman said.

Screening procedures at both sites are termed confidential. Two types of HIV testing are available in the state of Missouri. One type of testing is called confidential while the other is termed anonymous. Only three sites in the state administer anonymous testing. Those locations are found in St. Louis, Kansas City and Springfield, according to a spokesman for the state Bureau of STD/HIV Prevention.

Spokespersons for both the university health center and the county health department described the testing procedures at their locations as extremely confidential.

Missouri is termed a dual reporting state, explained Wendy Watkins, HIV Surveillance Unit Coordinator with the Bureau for STD/HIV Prevention. That means laboratories and physicians must report HIV-positive findings.

By state law, all HIV tests that come back positive -- regardless of where they are administered -- must be reported to the Missouri Department of Public Health. With the exception of tests administered at anonymous testing sites, the name of the individual whose HIV test was positive must also be reported.

Name reporting -- called confidential reporting -- to the Missouri Department of Public Health of positive HIV tests has been required in this state since October 1987, Watkins said.

The reasoning behind the confidential reporting is to "unduplicate" test results, thus providing a more accurate picture of the status of the disease in the state, she explained. It is not unusual for persons to seek more than one HIV test, particularly if the first test shows positive for HIV antibodies, Watkins said.

The identification information is protected by statute, she stressed. "There are penalties in the law if any information is revealed to anyone for any reason," she said. "We've never had a breach ... we're hypersensitive to protecting confidential materials."

In turn, states report the statistics, not the names, to the Centers for Disease Control.

A spokesman for the National AIDS Hotline said the Centers for Disease Control "recommends persons ask how the test result is going to be stored and who will have access to it."

AIDS reporting has been required nationally since 1982. Since that year, 5,077 AIDS cases have been reported in Missouri, according to the Bureau of STD/HIV Prevention.

In 1993, the AIDS case definition was broadened, causing the number of AIDS cases reported in the state that year to more than double the 662 cases logged the previous year.

The presence of HIV in the body does not always mean the individual has AIDS. According to the Centers for Disease Control, without treatment, half of HIV infected people will develop an AIDS-related illness within 10 years. HIV weakens the body's immune system, making it more vulnerable to other illnesses and infections. The HIV infection does not disappear nor at this point can it be removed from the body.

Fear of the unknown keeps many persons from requesting an HIV test, Craig said. She encourages persons to take the initiative and learn their status if they have any question at all.

"If they're wondering whether they need to have it done, they probably should have it done," she said.

HIV tests available

Cape Girardeau Health Department, 1121 Linden.

Testing is available on a walk-in basis and is free of charge. Anyone, including minors, can take part in HIV counseling and testing services at the Cape Girardeau County Public Health Center. Parental consent is not required. The county health department offers the HIV-antibody screening 9 a.m.- 3 p.m. each Tuesday.

Southeast Missouri State University, university health center.

Testing is available on a walk-in basis and free of charge only to currently enrolled university students and university personnel. No appointment is necessary at the center, which is open 8 a.m.-5 p.m. Monday-Friday during fall and spring semesters and 8 a.m.-noon and 1-4 p.m. Monday-Friday during the summer.

HIV testing is also available through Southeast Missouri Hospital and St. Francis Medical Center upon physician's request.