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A Response to the Vermont Health Department
A Response to the Vermont
Health Department
by Ric Kasini Kadour
Inaction
by the Vermont Department of Health (VDH) continues to block gay men's
access to rapid HIV testing in Vermont. The wait for HIV test results
in Vermont is currently one to three weeks.
I broke the story in the July issue of OITM
with an article that highlighted VDH's inaction and ignorance of the test
and its resistance to a national movement to implement the test. In August,
OITM published a letter by Vermont Department of Health HIV/AIDS Program
Acting Director Susanna Weller in which she "clarifies" some
of the information that appeared in an article on her program's failure
to implement a rapid testing system in Vermont. Weller's letter makes
three points. First she claims VDH evaluated rapid testing in the summer
of 2003. Second, she rightfully points out that Vermont's HIV testing
network delivers more HIV results than the national average. Third, Weller
says that OraQuick is "a screening test only."
Calling OraQuick a "screening test
only" understates its significance. Rapid HIV Testing is revolutionary
in its ability to confirm a negative HIV status or predict an HIV positive
result. Weller's attempt to discredit the test or downplay its significance
serves to excuse VDH's inaction, but rapid HIV testing is the future and
it will eventually be available in Vermont. VDH will then need to work
to restore the confidence in the test that they have, up until this point,
seriously undermined. This is public health at its worst: distorted and
near-sighted.
I decided to investigate VDH's "evaluation"
claims. I filed a request under Vermont's Public Documents Law for documentation
of their evaluation of OraQuick rapid HIV testing during the summer of
2003.
What constitutes VDH's evaluation, according to these documents, is a
series of information emails largely dealing with a funding proposal to
the CDC. At no point in the documents are concerns raised about the accuracy
or complexity of the OraQuick test. The Department of Corrections was
identified as the place to begin using the test, but the documents give
no reasons for starting with this population. While there is some discussion
in the documents of how to introduce rapid testing into Vermont, there
is no discussion of the cost of implementing and maintaining such a system.
Significant information that would indicate
the thoroughness of the evaluation was missing from these VDH documents:
a summary of community input, a cost/benefit analysis of using OraQuick
versus sending samples to the State's lab, an assessment of the value
the test would have to various high-risk populations, or even an estimated
budget of the funds needed to implement the testing.
The documents do show the enthusiasm for
the test by some VDH staffers. In a May 21, 2003 email, VDH HIV Counseling
and Testing Coordinator Kerry Coons writes, "Everyone here is very
excited about the prospect of bringing the rapid test to Vermont. As soon
as it's a real, sustainable possibility for us, we'll get it here."
Even after the summer of 2003, the period
during which Weller claimed VDH evaluated rapid testing, HIV/AIDS program
staffers continued pushing forward. In September, Weller forwarded information
on OraQuick to the State Lab. In October 2003, rapid HIV testing was included
in VDH's application for funding from the CDC. Also that month, VDH staffers
were discussing a training in using OraQuick with their counterparts in
New Hampshire. In November, Coons was exploring the issues of testing
minors. In December, staff raised the potential of rapid testing at a
New England meeting of HIV prevention public health officials.
Despite this enthusiasm, in June 2004 when
I approached VDH officials for the original OITM story, Weller declared,
"In Vermont, we predicted that 50 percent of our preliminary positives
would be false given the HIV prevalence for the population of Vermont."
In her August letter, she said, an 'evaluation' of the test "gave
us reason to not recommend rapid testing for the general population."
Which brings up a serious question: what
happened between late fall last year and this summer that made rapid HIV
testing suddenly wrong for Vermont?
In the August, 2004 letter that accompanied
the requested documents, Weller offers this explanation: "... our
CDC project officer, Kessler King, suggested that the rapid test would
make sense in select high-prevalence settings in Vermont, such as in Corrections
settings. He did not recommend that we consider its use for the general
population."
If King received the same documents that
I did, he would have no reason to suggest Vermont implement a rapid HIV
testing system. Quite simply, the VDH hasn't done their homework. Nothing
in the documents suggests an appreciation for the value of rapid HIV testing
or the impact it may have in Vermont. In fact, in spite of enthusiasm
for the test by some HIV/AIDS program staff, nothing in these documents
suggests VDH officials gave rapid HIV testing a meaningful evaluation.
People and organizations fail to do the
right thing out of inertia, indifference, incompetence, ignorance, or
malice – and sometimes a little of each. Instead of blaming inexplicably
high false readings or lack of CDC support, it's time for the Vermont
Department of Health to either explain exactly why they continue to block
access to rapid HIV testing or present a plan of action that reassures
the community they are being served in the best possible manner.
Ric Kasini Kadour is a gay men's health advocate living in Shoreham,
Vermont. Those interested in reviewing the documents mentioned in this
article should send an email to ric@kasinihouse.com