The HIV controversy – To test or not to test
by J. Yorke, B. Rapatski, F. Suppe
In September 2006,
the Centers For Disease control made a change in policy, asking for wide-spread
population screening to detect earlier people in the
Why is this radical shift occurring now and not ten years ago when effective antiretroviral treatment became available? Perhaps the medical establishment was fooled by research published in 1994 and 1997 indicating that broad testing would be ineffective at stemming the epidemic. Did those papers make absurd assumptions to prove their point? Is it really possible that gay men choose sex partners whose age differs from theirs by a median of 0.4 years? If they could, why would they bother?
James Koopman et al (1) assert that in sexual contacts HIV-1
is most infectious when the infected partner is in the “first” stage of
infection, the initial two-month period before developing antibodies to HIV.
Hence the standard antibody detection tests will not work during that stage. For
an epidemic that is nearly level as in the
If an infected person is detected, he or she will, with high likelihood, begin treatment with anti-retroviral drugs, and his or her infectiousness will plummet.
We believe that if the screening
policy is implemented effectively, many chains of infection, from person to
person to person ... will be stopped and the rate of new infections in the
(1) Papers by Koopman et al.
Jacquez, JA, Koopman, JS, Simon, CP, & Longini, IM. Jr., Role of the primary infection in epidemics of HIV infection in gay cohorts. JAIDS 7, 1169-1184 (1994); and
Koopman JS, Jacquez JA, Welch GW, Simon CP, et al. The role of early HIV infection in the spread of HIV through populations. JAIDS 14, 249-258 (1997).
(2) Brandy L. Rapatski, Frederick Suppe, and James A. Yorke, HIV Epidemics Driven by Late Disease-Stage Transmission, J. AIDS, 38, 2005, 241-253.
This paper asserts that late stage (stage 3) is more important than stage 1 for transmission.
(3) Letter to JAIDS editor by Koopman & Simon has a vicious attack on above paper (2), with over 20 criticisms.
The strong phrasing on this page is necessitated by the phrasing in (3).
(4) JAIDS response (in press) by Rapatski, Suppe, & Yorke to the Koopman & Simon attack (3).
This paper observes that Koopman & Simon believe their criticisms (though R-S-Y do not). These criticisms are equally valid for attacking the K-S work. “Koopman and Simon ... seem to severely criticize their own paper and choose not to defend it against our remarks.” Does Dr. Koopman believe that hypotheses should be changed and shifted until the results are those he wants, even if it is necessary to make absurd hypotheses?
Excerpts from a Washington Post article by
Susan Levine, Washington Post Staff Writer
published Saturday, June 24, 2006; A01
The District will launch a campaign
next week urging every resident between the ages of 14 and 84 to be tested for
HIV, an ambitious undertaking that public health officials say is critical to
reversing rates of infection that are among the worst in the country.
The citywide campaign, which appears to be unprecedented in its breadth, will target 400,000 men, women and teenagers and encourage them to learn their HIV status through an oral swab that delivers results in 20 minutes.
Organizers want the rapid test to become as common a part of any medical exam as blood-pressure monitoring or a cholesterol check. The hope is that the results, especially if positive, would influence a person's sexual behavior and motivate him or her to seek treatment.
Nationally, the CDC estimates, 25 percent of the more than 1 million Americans living with HIV are unaware they are infected.
Appleseed Executive Director Walter Smith applauded the campaign yesterday. "I don't think you'll find routine citywide testing anywhere in the country," he said. "It's an important and bold step forward, and we welcome it."
A monograph that created a theoretical underpinning for US policy on gonorrhea population screening policy:
Springer-Verlag Lecture Notes in Biomathematics #56, 1984.
(Out of print; copyright now retained by the authors)
Brandy Rapatski, Ph.D.
Natural Sciences and Mathematics