Published in The Plain Dealer (front page of the Metro section). Print version (PDF) PAGE 1 and PAGE 2.
Also published on Cleveland.com: http://www.cleveland.com/healthfit/index.ssf/2012/08/the_free_clinic_institutes_opt.html
By Casey Capachi
CLEVELAND, Ohio –Starting in late September, patients going to The Free Medical Clinic of Greater Cleveland for an annual physical will be asked to mark one of two new boxes on their consent to treat form: “Yes” or “No” for HIV testing.
The move is in an effort to identify those infected with HIV early, when treatment is most effective. The Centers for Disease Control and Prevention recommended all healthcare settings institute opt-out testing for patients ages 13-64 and all pregnant women in 2006.
Adriana Whelan, a nurse practitioner at the Free Clinic, said adopting opt-out testing has been “a long time coming.”
“HIV is still leaking out into the community,” said Whelan of new cases being diagnosed at the Free Clinic, especially in high-risk groups such as the homeless and the black MSM, or men who have sex with men, populations. The Clinic sees over 11,000 patients a year.
Whelan added that patients come to the clinic “all the time” believing they’re not at a high risk of contracting HIV.
“You can’t see HIV. You don’t know who’s positive or who isn’t. A woman could be in a monogamous relationship and have a partner with high-risk sexual activity and she doesn’t know it,” said Whelan. “We just had that happen.”
In Cuyahoga County, there were 4,519 people living with HIV/AIDS as of 2012, according to the Cleveland Department of Public Health.
In the U.S., there are about 1.2 million people living with HIV/AIDS, and 1 in 5 do not know they’re infected, according to the CDC.
The Free Clinic, says HIV Outreach Manager Kalia Johnson, has seen a steady rate of about 20-30 people test HIV-positive every year since 2006, both at the Clinic and through outreach testing programs, such as syringe needle exchanges.
Last year, the Free Clinic diagnosed 23 people HIV-positive. All except one were young black men ages 15-21 who have sex with men, said Johnson.
“If we test 200 people we can count on about four of those people being positive,” said Johnson of their work in at-risk communities.
Those patients, however, said Whelan, voluntarily opted to be tested for HIV and most likely had a specific concern.
“Honestly, I don’t know if we’re going to find more people because a lot of people who seek our services I wouldn’t say they’re necessarily high-risk patients,” said Whelan. “If we do opt-out testing, in addition to clinical testing, which includes going out to high-risk communities, we may increase numbers for the clinic overall.”
“Our main goal is to find out who is positive and get them into treatment.”
The Free Clinic discussed their new program with the federally funded Care Alliance Health Center, which, since February, has had an opt-out testing program for the at-risk homeless population they primarily serve.
In the next few weeks, Whelan said, the Free Clinic will be finalizing their consent to treat form and training staff to work with patients who may have questions about the testing process or their HIV status. The clinic will offer their pre- and post-test counseling services just as before.
Half of the Free Clinic’s funding comes from foundations, a quarter from individual donations and the remaining quarter from state and federal money, says Director of Volunteer and External Relations Melissa Ghoston.
“We have a policy that we accept everybody who doesn’t have health insurance and even for those who do, if they can’t access it or feel it would jeopardize it, we do take them in,” said Whelan.
Whelan said they do not expect the costs of the HIV opt-out program to create a financial burden, as the screening will be a part of an already-existing blood test for patients that the Cleveland Clinic processes for free.
She says the Free Clinic will use the Treatment as Prevention method once patients have been identified as HIV-positive. TasP, which has been gaining traction in the global fight against the spread of HIV, places patients on antiretroviral treatment as soon as they are diagnosed to reduce their viral load and the likelihood of transmitting HIV to their partners or babies.
The Free Clinic will continue to work on stopping the spread of HIV in the greater Cleveland area by informing at-risk communities.
“One thing I don’t want to get lost is the prevention piece of it,” said Johnson.
“It’s one thing to test someone, it’s another thing to educate them.”