At first glance, it seemed wasteful, almost insanely so. After the international AIDS conference in Washington, D.C., last week, health officials from B.C. were trumpeting mass population screening for HIV in their province, and eventually, beyond. According to the media reports, if we could get everyone who has ever been sexually active tested (on a volunteer, not mandatory, basis) it could mean “the beginning of the end” of AIDS.
Of course, there was much overselling in the media-with headlines like: “B.C. aims to end HIV/AIDS with widespread testing” and “B.C. launches massive program to wipe out HIV/AIDS.” But this screen-everybody approach also seemed dubious from a public health viewpoint. Given the well-known problems associated with over-testing, over-screening, and over-diagnosis in other areas of medicine-from PSA testing to pap smears-why try the catch-all method with HIV? What about the traumas related to false positives and the sheer monetary cost of such an encompassing plan? Plus, Canada doesn’t have a high prevalence of HIV/AIDS. Why would we adopt mass screening for a disease that mainly impacts marginalised or hard-to-reach groups that probably wouldn’t be captured anyway? Science-ish called Dr. Julio Montaner, one of the leading proponents of the program, to find out more.
The goldmine
Dr. Montaner, in his charming Argentinian drawl, began by working backwards to explain that the treatment of HIV (which causes acquired immunodeficiency syndrome or AIDS) is the most effective preventative tool we have. Once you identify a person with the virus, you can get her on antiretrovirals, which can extend her life and bring her viral load down so that she is less infectious. “What we have seen is that HIV testing is the entry point into this whole cascade of care,” he explained. The trouble in B.C. was that public health officials had actually exhausted HIV testing in the at-risk communities. But it was difficult to capture the minority who may not have a known risk factor and may be living with the virus. With mass screening, he said, “We’re hitting the gold mine.”
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