According to the Public Health Agency of Canada (PHAC), there are about 71,000 HIV-positive people in Canada, 25% of whom do not know their infection status. Such people, unaware that their immune systems are slowly being degraded by HIV, may only seek care once they become very ill.
A recent study from France focused on people who sought care relatively late in the course of HIV disease. Researchers in that study found that people with a “moderate degree of immunodeficiency” who have between 200 and 350 CD4+ cells are at an elevated risk of death compared to HIV-positive people who have more CD4+ cells. Thus, earlier HIV testing and swift referral to care and treatment with potent combination anti-HIV therapy (commonly called ART or HAART) would have likely resulted in better survival. Furthermore, early diagnosis and treatment of HIV is less costly than waiting until someone is very ill.
Some people may not choose to get tested for HIV for the following reasons:
- They perceive themselves to be at low risk for this infection.
- They worry about having a positive test result, in part because they may view HIV as a deadly disease rather than a chronic infection that can be managed with effective medicines.
- They are concerned about the confidentiality of their test results.
- They lead busy lives and find visiting a clinic or doctor inconvenient.
As people who are unaware of their infection status may only seek care when they are very ill, researchers have been increasingly calling for Emergency Rooms (ER) to offer HIV testing and counselling as part of normal ER assessments. Some hospitals in high-income countries are evaluating such testing and we now present a study done at one hospital in Canada.