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National HIV Testing Day 2008 Webinar

National HIV Testing Day 2008 Webinar for Bloggers
June 17, 2008
2:00 pm ET

Timothy Harrison: Welcome to our 2nd National HIV Testing Day Webinar sponsored by AIDS.gov. I'm Timothy Harrison with HHS' Office of HIV/AIDS Policy which manages AIDS.gov. Thank you joining us today for the discussion on HIV testing.

The goals of this Webinar are to heighten awareness and understanding of HIV testing, encourage bloggers to promote HIV testing to their readers, link readers of blogs to places they can get and HIV test in their communities and talk about June 27th, National HIV Testing Day with the blogging community.

The impact of the blogesphere continues to expand. Bloggers are increasingly shaping public opinion of almost every conceivable subject including public health. As leaders in this sphere you have the power to reach a broad audience with HIV prevention, testing and treatment messages. We are very excited to be working with you.

Today we'll hear from Dr. Bernie Branson, Associate Director for Laboratory Diagnostics at the U.S. Centers for Disease Control and Prevention; Dr. Celia Maxwell, Assistant Vice President for Health Sciences and Director of the Women's Health Institute at Howard University Hospital; Mr. Andre Blackman, Social Media Strategist and Writer for the Pulse and Signal Blog.

You will have two opportunities to ask questions. Please enter your questions into the question box on your screen and they will be sent to us.

Dr. Branson, thank you for joining us today. Could you start by telling us a little bit about your role at the CDC?

Bernie Branson: Thanks very much. I am the Associate Director for Laboratory Diagnostics at the CDC where I am involved in doing research both on different diagnostic tests and on different strategies for HIV testing in order to help the 1/4 of persons who we assume are undiagnosed to find out about their HIV status.

Timothy Harrison: Thanks Dr. Branson. As we near the year the 30-year mark of the HIV/AIDS epidemic many people of the U.S. have come to regard HIV as simply another chronic illness like Diabetes that can be treated with medication. From your perspective, why should we be concerned about HIV and why is HIV testing so important?

Bernie Branson: We need to be concerned about HIV because as you mentioned it has become a treatable disease like Diabetes only if persons are aware that they're infected and they take advantage of the treatment that's available. If you can show the next slide, in the most recent surveillance data from CDC what we see is of the people who are reported between 2002 and 2006, about 2/3 of cases among men or among men who have sex with men but an increasing proportion 16% or men and 79% of women acquire HIV as a result of heterosexual transmission.

The next slide shows something that I find considerably disturbing in that 49% of all reported cases of AIDS in the United States occur among African Americans who represent only 12% of the population. Now this slide talks about reported cases of AIDS.

If you could go on to the next slide it looks at information from the National Health and Nutrition Examination Survey which takes a sample from across the country and shows that among younger persons agen - age 18 to 39 the epidemic is not very evenly distributed. Nearly 2% of black males and 1% of black females in the younger age group is infected with HIV. In the older age group 4-1/2% of black males and 2.78 nearly 3% of black females in this country as well as about 1/2 a percent of Hispanic males and Hispanic females are infected with HIV. Many of these people are unaware of their infection and unable to benefit from the advantages of the medication that can essentially give them a normal life expectancy if they're diagnosed and treated.

Timothy Harrison: Great. Thank you. Based on what we know about the epidemic, who does the CDC recommend should get tested for HIV?

Bernie Branson: CDC continues to recommend that persons who are at high risk for HIV including men who have sex with men, person's who have symptoms or are being treated for sexually transmitted diseases for other STD's and people in TB clinics be tested. However, if you show the next slide, CDC is also recommending much more expanded testing such that all adults, adolescents and pregnant women who encounter the health care system should get tested for HIV because we believe that everyone in the United States should know their HIV status.

Timothy Harrison: Great. Thank you for that information Dr. Branson.

Dr. Maxwell thanks for being with us today. Could you please tell us about your current work?

Celia Maxwell: Oh sure, thank you for having me. It's great to be a part of this event. I am currently the Assistant Vice President for Health Sciences at Howard University but I have been working in HIV for almost 24 years as a clinical infectious diseases specialist and currently as part of my duties I am leading a program here of routine HIV screening in the entire hospital. So that we offer this service to anyone coming through the facility whether they're here for a broken leg or for plastic surgery.

Timothy Harrison: Great. Thank you Dr. Maxwell. Can you tell us what happens when someone goes to get an HIV test at Howard University?

Celia Maxwell: Well it's not much different from getting any other test at Howard. Basically we use primarily the rapid test which is a normal test. It's quick and results can be given to the person in as little as 20 minutes. It involves a swab of the inner lining of the mouth. We also can do the test by drawing a - a blood sample but it's - it's pretty easy. We make it accessible to patients even as they're waiting to see physicians for other reasons, so, it's really easy to get a test done and we encourage it to all our patients and even visitors that are coming through the facility.

Timothy Harrison: Great. Now we will take a few questions from our bloggers.

Okay, we have one question here from (James). Is there data on why people do not - why people do not take an HIV test? Would anyone like to address that?

Bernie Branson: I'd be happy to address that at least in part. The evidence that CDC has accumulated is that many people don't take an HIV test because they don't believe they're at risk. In several studies and demonstration projects that we have conducted we have found that up to half of the people who are found to be HIV infected number one, have never been tested before and number two, don't have any of the classically identified risk factors.

I think of more concern to us was the study from North - from South Carolina where they looked at people who were diagnosed with HIV and they looked at how many health care visits they had had in the several years prior to their being diagnosed and they found that 75% of people had encountered the health care system but never got tested for HIV. And I think that lends a lot of support to Dr. Maxwell's program which is ensuring that in a time when there's effective therapy available no one walks through a health care system without being asked about HIV testing.

Celia Maxwell: And - and if I could just add to what Dr. Branson has just said, in our experience here at Howard not insignificant number of persons were quite shocked that they had not been tested. Many patients assume because we draw the volumes of blood, that they have been tested. And so it was surprising to me in addition to that, some of the people that I've encountered that refused to be tested stated they were afraid to find out the results because of their fears of stigmatization and the like and that's one of the reasons that we offer it to everybody. It doesn't matter what the circumstance tried to diminish the stigma that might be associated in some peoples mind with taking this test.

Timothy Harrison: Great and then if we could sort of talk about that further Dr. Maxwell. Why is it a tough to ask a doctor about taking an HIV test?

Celia Maxwell: You know, I can only surmise certainly it's not tough for me but I know that many of my colleagues refer anything that maybe has to do with sex to me as - as the infectious diseases doctor. I think that some clinicians are uncomfortable talking about sexual health with patients and I'm obviously not and I think also that there's the assumption by many that if the patient has been in the practice for X number of years particularly if the patient is more mature -- and you notice I say more mature as opposed to elderly or older -- that perhaps there is no risk and so I think the conversation that needs to be started really is not where it needs to be with health care practitioners. I think that is a major reason.

Timothy Harrison: Okay, excellent. And continuing this thought, what kind of treatment can a seropositive person get once tested?

Bernie Branson: There are a couple of things. I think first of all many people who have HIV infection simply need monitoring for a period of time to see when treatment needs to be started and I think that's an important consideration. Not everyone who is diagnosed needs to immediately go on therapy. However now there are a host of different antiretroviral agents that are different drugs that people can take and the dosing regimens are much simpler, very often they can be taken just in a one pill a day format for the combination of medications that they take. And the most interesting data shows that basically that a person who's age 25 if they're diagnosed early and they get monitoring and treatment is started at the appropriate time, their life expectancy is essentially the same as a an uninfected counterpart.

Timothy Harrison: Great, great. Another question here. Do some states have mandatory testing? This is for Dr. Branson.

Bernie Branson: The only states that have required testing relate to testing mother's of newborns whose status is not known at the time of delivery. And currently I believe that Illinois, New Jersey, Connecticut and New York have those requirements. There are no other states that have mandatory testing except of course, all persons who are donating blood or organs because all of those individuals are tested before the donation.

Timothy Harrison: Okay. And we have another question here it appears. The question is, is there a person living with HIV on the panel? And...

Miguel Gomez: There were actually several consumers who helped organize this panel but on our panel today we do not have someone identified who's living with HIV at this time.

Timothy Harrison: Okay, then we will move right along.

Celia Maxwell: Okay.

Timothy Harrison: Let's return now to our third speaker, great. Mr. Blackman from Pulse and Signal Blog, welcome and thanks for joining us today.

Andre Blackman: Hi Tim and thank you for definitely having me here. I'm happy to be here.

Timothy Harrison: Great, great. What is your blog about?

Andre Blackman: My blog just looks at the intersection of health, health education, health communication promotion and the intersection with social media and technology, personal technology. So that's what my blog is about.

Timothy Harrison: Great, great. Mr. Blackman please share with our listeners your experience of finding your local testing center.

Andre Blackman: Absolutely. When I was doing a Google search for HIV testing I saw that the first search result was HIVtest.org Web site. This is perfect, because it's one of the best sites to go to for reliable information from the CDC. The fact that a testing center locator is placed right on the home page is great. So the fuel is easy to find and all you need to do is drop in your zip code and you can quickly find a local HIV center. In other searches on Google such HIV testing locations also brought up credible links to CDC and AIDS.gov. So in my opinion when - when consumers are - are looking for health information online simple is definitely better.

Timothy Harrison: Great, great. Thank you for that Mr. Blackman. Dr. Branson, where should bloggers direct their readers if they're interested in getting tested for HIV?

Bernie Branson: I'm glad you asked that question. I think there are a couple of places. First of all I think many people ought to consider asking their usual source of heath care, their doctor or their HMO about getting HIV tested and I think in fact they should command to get HIV tested when they encounter the health care system. The second as Mr. Blackman just pointed out, is the Web site HIVtest.org and then the third which I think is a useful resource right now people can get information via their cell phone through the Knowit text messaging campaign. That's K-N-O-W-I-T. This is a partnership with the Kaiser Family Foundation, the CDC and AIDS.gov so that people who can test their ZIP code to “KNOWIT”, that's “5-6-6-9-4-8” they can find a testing location. Bloggers can add the web badge to their blog about this whole thing by getting the necessary code at www.AIDS.gov/knowit.html.

Timothy Harrison: Those are great resources. I also know that the CDC worked with the University of Georgia as students to develop personal public service announcements about HIV testing. Would you please tell us a little bit about this?

Bernie Branson: Yes, thanks for asking. Back in April the CDC partnered with the University of Georgia and brought together teams of students from six different Universities to create some testing public service announcements that were suitable for cell phone distribution. Therefore, it's the term “personal” public service announcements. The explosive growth of YouTube and the host of other video sharing networks success to the popularity of user or peer generated content. All - also we know that today user less tuned in to broadcast radio and TV than before and that mobile media provides a unique opportunity for us to reach young people with information to help them stay healthy. So this public service announcement project provided a great opportunity to create peer generated messages on the importance of testing for mobile media.

Timothy Harrison: Great, great. Okay. Dr. Shamp would you like to add anything?

Scott Shamp: Sure, this is Scott Shamp, I'm a Director of the New Media Institute at the University of Georgia and I was one of the co-conspirators in the project that you just heard about using cell phones to produce messages encouraging young people to be tested for HIV. The cool thing about this project is that it - it put cell phones in the hands of college students and gave them one day using that cell phone to produce video's to be distributed to cell phones encouraging young people to be tested for HIV. And all of those videos are available through the CDC and the a - a couple of the other sites for the people - for people to embed in their own blogs to show people. I think they're really clever and they're creative and they explored a lot of different avenues of AIDS testing that seasoned medical professionals wouldn't find as relevant as 18 to 25 year-olds would.

Timothy Harrison: Great, great. Thank you. Dr. Maxwell, what are some of the reasons people don't get tested for HIV?

Celia Maxwell: That's a good question Timothy and I think that Dr. Branson alluded to some and I did before but just to reiterate. One of the reasons that people have told me that didn't want to get tested was they were actually afraid of finding out the results. Another reason was they did not see the risk at all. Another reason would be things like, you know, I have been going to my doctor for a number of years, if there was a problem he or she would - would have told me and a whole host of reasons. I think though what it shows is that we have to continuously empower our patients and those that we encounter about the importance of knowing the HIV status and dispelling some of the myths that there are about getting tested for HIV.

Another one that some of my patients have told me and this was not surprising to me was that they were afraid that by allowing me to test them, they would get infected so that the government could track them more readily. And this goes back a lot to feeling of distrust of organized medicine and the government in general because of past history like in Tuskegee. And so the reasons have been many; however, the overwhelming majority of patients that I have approached -- and I've approached about 20,000 in the last year and a half -- the overwhelming majority about 15,000 have agreed to be tested and thought it was a good thing. Some have even brought family members to be tested.

Bernie Branson: Excuse me if I might add to that. One thing we have found in some of other testing campaigns is that a good number of people say that they're not getting tested today because they've been tested before or because they've already had an HIV test and I do want to remind people that we encourage folks who have continuing risk factors to get tested at least once a year so that an HIV test is not like a vaccination, you get one once in your life and that's all you have to worry about.

Celia Maxwell: Yeah. Good point, good point.

Timothy Harrison: Great, great, thank you. Now I want to turn back to Mr. Blackman. How do you think new media and the blogesphere can help to improve awareness of HIV/AIDS and getting tested for National HIV Testing Day on June 27th?

Andre Blackman: That's a great question Tim and something I'm very, very passionate about. So as a blogger at Pulse and Signal.com and in my experience with other bloggers, I found that the use of social media initiatives have been successful in garnering the attention of the public for good causes. And in the case of, you know, HIV/AIDS awareness this is definitely no different.

So there are plenty of bloggers who write about making a positive impact in our society and messages that resonate with blog readers have the tendency to go viral and spread to the most receptive audiences. Facebook's Causes application is a great example of how social networking can bring attention and support to a great cause. And finally, with shareable media such as banners and widgets to place blogs and Web sites the multiplying factor of awareness gives the opportunity for great success. Now people can place these banners and widgets on their sites and then other people who come to the Web sites do the same thing so it just adds to - to the momentum of - of spreading the word. And also I'd just like to leave a parting thought with the social media as a whole is that it's the voice of the people and that's exactly what we're focusing on with National HIV Testing Day.

Timothy Harrison: Great, great. Now we'll again respond to questions from the bloggers participating on today's Webinar. And it looks like we have one here for Dr. Maxwell. When you go to a doctor or emergency room should you be offered an HIV test?

Celia Maxwell: Well I think that when you go to a doctor it should be part of your well-care or your care in general. In emergency rooms because often times people are not being followed-up it might not be offered. But we found that it was an opportunity for us to get people that we may not ordinarily get into the system of care. So I think it's a good idea to offer HIV tests wherever a patient, whether it's an outpatient clinic, whether it's an inpatient setting or an emergency room.

Timothy Harrison: Great, great. For Dr. Branson, why do you believe doctors are reluctant to offer an HIV test?

Bernie Branson: We have different messages with respect to that issue. Some doctors are - actually our focus group have shown that some doctors are afraid that they're patients might be insulted. This is I think related to sort of risk based testing that when there was this concept out there that having HIV disease was somehow a marker of - or getting an HIV test was a marker of having something that was socially undesirable in terms of behavior. Whereas patients when it's offered routinely as something that everybody gets, they don't have those same kinds of concerns. There has also been traditionally I think a lot of additional work associated with doing an HIV test such as specific separate sign-in formed consent or specific kinds of counseling that formally have been recommended. CDC changed those recommendations in 2006 in order to streamline the process and make it easier for doctors to do an HIV test the same way they would do any other screening test for health condition and I think that it would be less common for doctors to be reluctant to offer HIV testing.

Timothy Harrison: Great. And for Dr. Maxwell. Why is HIV testing not mandatory?

Celia Maxwell: Well there's really no test that's mandatory to the best of my knowledge except maybe a syphilis test before marriage in some states and for some pregnant woman. Why is it not mandatory? The best way I could answer that is I don't think any test should be mandatory. It's really should be a discussion between health care practitioner and their patients and offering it as part of their wellness care. And so I believe anything that is mandatory might cause people to be afraid and drive them on the ground. I think it should be just a part of what keeps you well. And I often say to patients this is really no different than getting your Pap smear if you're a woman, getting an anal Pap smear if you're a man that has sex with men, getting your PSA if you're a man of a certain age or knowing your cholesterol. This is part of being well.

Timothy Harrison: Great. And we have a question for Mr. Blackman. Have you written a blog post on getting an HIV test we can link to?

Andre Blackman: That is actually something I plan on doing next week and I absolutely plan on writing a blog post about it and I definitely encourage other bloggers to do the same thing who are - who are interested in - in getting rid of any kind of false stigma's surrounding the HIV test.

Timothy Harrison: Excellent, excellent. Dr. Branson, Dr. Maxwell and Mr. Blackman, do you have any closing comments?

Bernie Branson: Well I would like to encourage bloggers to focus or concentrate the immediate efforts on National HIV Testing Day which is coming on June 27th. This is something that was started by the National Association of People with AIDS more than 15 years ago in order to encourage awareness and encourage people to get tested. And I think it's a unique opportunity to bring attention to something that really needs to be happening in the United States.

Celia Maxwell: And I would add to what Dr. Branson has said that for all of us it is important to know our HIV status. It's really as important as any other health maintenance test that you get and actually you should demand it of your clinicians if they don't offer to have it done.

Andre Blackman: And I would - I would just like to mention regarding social medium once again it - it definitely has great potential to amplify other initiatives in public health. If we just take the time to get involved and learn about this new landscape we can definitely begin to see great things in our world and in our lives.

Timothy Harrison: Great. Thank you all for your comments today. Well that concludes our Webinar in advance of June 27th, National HIV Testing Day. Thank you all for participating today. We hope you have - we hope you've learned some useful information and will start conversations about getting tested and National HIV Testing Day. For additional information please visit AIDS.gov. A copy of today's Webinar, transcript and graphics will be posted there soon. Have a great day.