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Miami Jackson Memorial Hospital ER & 50 Emergency Rooms Begin HIV testing
  Miami Herald
Posted on Thu, Apr. 06, 2006
In an ambitious effort to identify some of the thousands of South Floridians who have HIV but don't know it, patients who walk into the emergency room at Jackson Memorial Hospital will soon be offered a routine test for the virus that causes AIDS.
Officials hope the program, set to begin later this month, will not only get more people into treatment but also slow the person-to-person spread of the virus.
In South Florida, where the rate of HIV infection is among the highest in the nation, more than 30,000 people are HIV positive. One in four don't know they're infected, the Centers for Disease Control and Prevention estimates.
''Testing is an intervention because you start treating them before they get ill,'' said Dr. Daniel Gurr, Jackson's associate director for emergency services. ``But it's also prevention: When someone knows they're positive, they can take steps to protect their spouse, or whoever they are involved with.''
Many states, including Florida, have strict rules governing HIV testing procedures. The rules were designed to protect patients' rights, but they have had the unintended consequence of separating HIV screening from routine medical care.
The CDC has called for expanded testing nationwide, and a set of guidelines likely to be adopted later this year recommend that everyone between 13 and 64 be tested at least once.
''We think that the epidemic in the U.S. is continuing largely because people don't know their status,'' said Dr. Tim Mastro, of the CDC's division of HIV/AIDS prevention.
In recent years, the virus has moved into heterosexual communities in poor South Florida neighborhoods, where many lack access to routine medical care and use Jackson's emergency room as their medical provider.
''Not having money, you don't go to the doctor,'' said Dr. Michael Kolber, Jackson's director of adult HIV services. ``So what do you use? You use emergency rooms.''
The Jackson program will be staffed by full-time HIV counselors who circulate in the emergency room offering testing. The Florida Department of Health is paying for the testing kits; a $100,000 grant from Gilead Sciences, which makes HIV medications, is paying staff salaries for the first year.
The tests will be free but available only to those admitted to Jackson's emergency room with a medical problem.
Patients who decide to be tested will be given a private pre-test counseling session and a rapid test, with results coming in about 20 minutes. Those who test positive on the rapid test and a second, confirmatory, test will be referred into HIV care.
It's too soon to say exactly how many people will be tested, Jackson officials said. But they estimated that the program could test more than 5,000 people in its first year. Doralba Munoz, executive director of Union Positiva, which offers HIV testing to Miami's Hispanic community, cautioned the emergency room could be a difficult place for a person to learn he or she is HIV positive.
''Emergency rooms are chaotic,'' she said. ``It's difficult to have a controlled environment -- it's like opening a can of worms.''
But Jackson, which treats many of the HIV-positive patients in South Florida, may be well suited to deal with those issues, Munoz said.
''Jackson has the expertise in dealing with HIV patients,'' she said.
Officials at public hospitals in Broward County said they have no current plans to offer HIV screening in the emergency room.
In the 1990s, studies in several urban emergency rooms found a high rate of HIV infection. At Chicago's Cook County Hospital, half of the emergency room patients who tested positive did not think they were at risk.
But it was not until 2004, when the FDA approved a new rapid test, that emergency rooms began to consider offering routine testing, said Dr. Richard Rothman, a Johns Hopkins emergency room doctor who has studied HIV screening.
That has spurred an increase from fewer than 10 emergency room screening programs in the country two years ago to somewhere between 30 and 50 that are in place or in the planning stages, he said.
The results at Johns Hopkins, which was one of the first emergency rooms to begin HIV screening, and at other hospitals, have been promising, Rothman noted.
''People were skeptical because things are so busy in the emergency department,'' he said. 'My direct experience, and my understanding from other peoples' programs, is that it hasn't been a problem from either a doctors' or a patients' standpoint. The key now is gaining wider acceptance in more emergency departments throughout the county.''
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