President’s Corner: What You Don’t Know Can Hurt You!

What You Don’t Know Can Hurt You!

Dr. Freda M. Bush, July 2018

During the month of June, various HIV Testing Days were held across the United States. The objective is to encourage HIV testing among people aged 13-64 and improve availability of HIV testing in communities burdened with undiagnosed infections. Federal efforts to reduce undiagnosed HIV infection include providing educational campaigns to the public and healthcare providers on the importance of HIV testing and increasing program awareness within state and local health departments as well as for community based organizations. Records show many people have the disease three years before diagnosis and initiation of treatment.   An estimated 1.1 million people in the United States are living with HIV. About one in seven are unaware of their infection. As a result, they are not accessing the care and treatment they need to stay healthy and reduce the likelihood of transmitting the virus to their partners.1

Several years ago, in private practice, a patient came in for examination. She generally did not feel well and had noticeably lost weight for no known reason. Neither her husband nor her three children reported any leading health  complaints. Due to the unexplained weight loss and some changes in her skin, I did a series of blood tests, including screening for syphilis and HIV. When the results of her blood test returned positive for HIV, she was devastated as she had no telltale signs or knowledgeable risk factors prior to testing. Her husband was also tested and found to be HIV positive. Her care for treatment was then immediately transferred to the Infectious Disease specialist, but I stayed in touch with her for support.  Treatment for her was unsuccessful. My patient who came in for what seemed like a routine health check, died 3 months later.

For people at high risk for HIV, in addition to testing, the CDC now recommends taking pre-exposure prophylaxis (PrEP). It involves taking an antiretroviral (ARV) pill daily in addition to other preventive behavioral measures. This is a protective measure for those not diagnosed with HIV but who may be at substantial risk of becoming infected because of their lifestyle or as a partner in a sero-discordant lifestyle.2 If either spouse in the sad illustration above had been diagnosed early with HIV, the un-infected partner may have remained un-infected with PrEP treatment and some lifestyle changes.

Anal intercourse has an especially high risk for getting HIV. The CDC acknowledges that anal intercourse is the riskiest sexual behavior for acquiring and transmitting HIV for men and women. Heterosexual women in particular, have a higher risk, being that the receptive partner is 13 times more likely to get HIV then the top inserting partner.Women, in this case, will always be the receptive partner.

HIV testing day is important in that it encourages people to become more educated and take charge of their health through awareness days, campaigns and program implementation to further reduce and prevent risks. Other mechanisms for encouraging testing and treatment are billboard campaigns which are not only eye-catching to the general public but are also influential. One billboard of note encouraged behavioral change with the warning: Avoid AIDS! As easy as


Be faithful


CDC Testing is available at state and local health departments and some community organization clinics year round. Also testing is done at private medical clinics. Feel free to contact the local health department or the CDC for testing locations.


  1. Supporting Widespread Testing and Timely Linkage to Care, CDC, “Anal Sex and HIV Risk,”
  2. Pre-Exposure Prophylaxis for HIV Prevention: Safety Concerns. Raymond A. Tetteh,1,2 Barbara A. Yankey,3 Edmund T. Nartey,4,5 Margaret Lartey,6 Hubert G. M. Leufkens,1,7 and Alexander N. O. Dodoo4Drug Saf. 2017; 40(4): 273–283. Published online 2017 Jan 28
  3. CDC, “Anal Sex and HIV Risk,”