Reconsidering the policy on HIV testing
In this report, a Health Council Committee examines the question of whether the new possibilities for treating HIV infection have implications for policy on HIV testing.
The policy on HIV testing in the Netherlands is characterized by a spirit of reserve which is partly the result of recommendations issued by the Health Council. In recent times, combination therapy consisting of one protease inhibitor and two replication inhibitors (otherwise known as triple therapy or ’highly active antiretroviral therapy’ (HAART)) has been shown to be effective in the treatment of HIV infection. This affects the balance between the advantages and disadvantages of testing for HIV: in general the benefits now outweigh the drawbacks. The Committee is in favour of a more active testing policy and has arrived at the following recommendations.
* An active HIV-testing policy should be implemented with regard to pregnant women. By means of a few simple questions, the healthcare professional concerned should establish whether the woman in question belongs to a high-risk group and, if this is the case, offer the possibility of an HIV test. The test should also be offered in cases where risk status is uncertain.
* In cities with a relatively high prevalence of HIV infection (such as Amsterdam and Rotterdam), a study should be carried out to compare the benefits of the risk-based approach outlined above with a general screening programme of all pregnant women for HIV-infection. The Committee advises against general screening at present due to the low prevalence of infection.
* HIV tests should also be offered to all individuals who belong to a high-risk group. This includes individuals who:
- have or have had a partner who is HIV-positive
- have used intravenous drugs since 1980, particularly those who have shared syringes or needles
- have lived since 1980 in an area where AIDS is endemic (e.g. Sub-Saharan Africa and the Caribbean) or individuals who originate from these areas
- have undergone an invasive medical procedure since 1980 in an area where AIDS is endemic
have had a transfusion with blood or blood products between 1980 and June 1985 or after 1980 in countries where blood is not routinely screened for HIV antibodies
- have or have had a large number of sexual partners
- have or have had a bisexual partner
- have or have had a partner from one or more of the groups indicated above and men who have or have had sexual contact with other men.
* The Committee sees no reason to alter the present policy of reserve with regard to medical examinations for insurance purposes.
* In accordance with the Medical Treatment Agreements Act, the healthcare professional concerned should provide the patient with sound information about the HIV test to enable him or her to make an independent decision. In this regard, the Committee urges the relevant professional groups to devote a great deal of attention to training those in a position to offer the HIV test.
* The Committee recommends that clear written information material be drawn up regarding the change in the position on the advantages and disadvantages of HIV testing.
* Lastly, the Committee indicates that, in cases where an individual tests positive for HIV, the patient should be referred to a physician experienced in the treatment of patients who are HIV-positive or who have AIDS. This is of particular importance in the case of pregnant women who are HIV-positive: only treatment carried out by experienced experts in accordance with a protocol can minimize the risk of teratogenic effects.