Suicidal ideation and HIV testing

Article Abstract:

Persons who are told they are infected with HIV (human immunodeficiency virus) sometimes become suicidal. Two studies that reviewed death certificates of men with AIDS (acquired immunodeficiency syndrome) found the rate of suicide was greatly elevated. One of these studies found that men who had AIDS had 36 times the rate of suicide of men who did not. Some physicians may be reluctant to order HIV testing for this reason, but there is not enough evidence to determine whether their reluctance is warranted. Three hundred volunteers were evaluated regarding having thoughts about suicide before and after testing for HIV; the volunteers were all at risk for HIV infection but did not have symptoms and did not know whether they were infected. The subjects were evaluated with written tests and also during counselling sessions with a psychiatric nurse, both two weeks before and one and eight weeks after HIV testing. Of the 49 subjects who tested positive for HIV infection, 28.6 percent expressed suicidal thoughts before testing, and at one and eight weeks after receiving the results, 27.1 and 16.3 percent respectively had suicidal thoughts. These results show that suicidal ideation did not increase during the two months following positive test results, and actually decreased significantly between the first two evaluations and the eight-week follow-up. Among subjects who tested negative, suicidal ideation decreased from 30.6 percent before testing to 15.9 percent at eight weeks; the persistence of suicidal thoughts was considered surprising and alarming in this group. Suicidal wishes or intent, which indicate a greater readiness to commit suicide, were only expressed by 4.7 percent of the total subject population; these individuals were found to be clinically depressed. It should be noted that all subjects received extensive, supportive counselling at all sessions which helped to identify those at risk for suicide; the authors do not recommend testing for HIV without counselling. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Prevention, Statistics, Suicide, Suicide prevention, AIDS patients, AIDS virus carriers, HIV carriers

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Interpretation and use of the Western blot assay for serodiagnosis of human immunodeficiency virus type 1 infections

Article Abstract:

Various blood tests are now in use for human immunodeficiency virus (HIV), the virus that causes AIDS (acquired immunodeficiency syndrome). These laboratory tests are employed in diagnosing both symptomatic and asymptomatic individuals and for screening blood donors. For a test to be valuable it must be both specific to the particular virus and sensitive enough to detect the signs of infection, which are typically antibodies to HIV. The blood test in widest use for detecting antibodies to HIV-1 is enzyme immunoassay (EIA). If a blood sample is repeatedly reactive in the EIA procedure it is then retested with an additional and more specific method such as the Western blot. Guidelines for interpreting Western blot results are presented. However, there has been some controversy over how the laboratory findings should be read. The Public Health Service has stated that no patient should be designated positive for HIV exposure until the initial test has been reactive at least twice and another more specific test, such as the Western blot, has confirmed the initial findings. Results should be reported as positive, negative, or indeterminate, meaning inconclusive. Persons with indeterminate results should be retested at certain intervals. Increasingly accurate methods are needed to reduce the number of false-positive results (reporting a blood sample as positive for HIV when it is not); genetic engineering techniques show promise for this purpose.

Standards, Diagnosis, AIDS (Disease), Diagnostic services, Western immunoblotting, Western blot

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Mandatory premarital testing for human immunodeficiency virus: the Illinois experience

Article Abstract:

There have been 94,000 cases of acquired immunodeficiency syndrome (AIDS) reported in the U.S., and it is projected that there will be a total incidence of 270,000 cases by 1991. In response to the growing concern over AIDS, 33 states are considering some form of premarital testing for the human immunodeficiency virus (HIV). Currently only Illinois has mandatory premarital testing. In the first half year of the program's operation, the Illinois program tested 70,846 applicants for marriage licenses. Of these individuals, 8 tested positive for infection with the AIDS virus (seropositive), and approximately half of them had a lifestyle which indicated risk for infection. The cost of the testing was approximately $2.5 million or $312,000 for each individual detected positive. County clerks in Illinois reported that the number of marriage licenses issued each month declined from the stable number of the two previous years by approximately 22.5 percent. During the same period, the surrounding counties across the Illinois state line increased by a similar number. Premarital testing appears not to be a cost-effective means of controlling the disease.

Health aspects, Marriage licenses

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