Apparently, in the next three years, every adult in the Bronx, will be required to take an HIV test... voluntarily.
Let me tell you a couple of things. More than fifty (yes, 50) per cent of the Bronx is Hispanic (with the largest Dominican and Puerto Rican population in the United States). In fact, there are many areas in the Bronx where not a lick of English is spoken. People are not going to be interested in getting HIV tests. They wait too long to get treatment for HIV for the same reason that they wait too long to get treatment for breast cancer, or any other such disease. Trust me, I did my fellowship in the Bronx. These people are not stupid, nor illiterate; they are simply IN DENIAL.
These are the kind of people where instant gratification is in its exact meaning. Mobile phones, bling, labels on clothes are much more valuable than the spots on their skin or their rotting teeth or that lump on the breast that now is eroding through their skin. They do NOTHING until it hurts. And, well, let's face it--HIV does not hurt, not until it is too late, same with breast carcinoma, or any other carcinoma.
Now, let me tell you a more personal story: When I was in my fourth year of surgical residency, there was a certain (ehem) gentleman in our SICU s/p trauma. The trauma consisted of a 3 AM "But I was just on my way to church, and was jumped by some dudes" sort. Now you are getting the picture. So, now, this dude is vented in my SICU and I need to place a line and, sure enough... I stick myself. We know NOTHING about his HIV status.
I call my attending. "No big deal (!), just talk to the wife (he had one), draw the test, and we'll get a result by the morning." "Got it." The wife was overly willing to help--very sweet. I go to the bedside to draw blood, and my right arm is seized by a nurse. "What are you doing?" She growled at me. I explained the situation to her. I had a great rapport with all of the nurses, so I couldn't figure out what the problem was.
Well, apparently, the New York City laws are such that ONLY the patient can say OK to an HIV test. And this kind RN is just trying to protect the patient. It doesn't matter that he is on a vent and on a drip--SEDATED--so that he doesn't rip all of his lines, etc out. She is "just looking out for the patient's rights" she says to me with a sweet smile on her face.
This actually went to the hospital's ethics committee, and they could do nothing. The only consolation that I had was that we could draw a hep B titer, which came back fine. And, in theory, if that is negative, well then, he shouldn't have HIV. But, can you really deal with shouldn't when you have your WHOLE LIFE to live, your entire career ahead of you--in SURGERY, of all things?! I ended up taking a full course of HIV meds, and being sick for 3 months. When the "dude" finally came to, he took the test and (thank God, but also, of course) tested negative.