Talk:HIV screening in the United States

Links and citations

The sources used in this article can't be verified because they don't contain links. Moreover I ran Google searches for a handful of them and there were several I couldn't identify. Jazz14, could you please help out by adding links for all references? See Wikipedia:Citing sources#Links and ID numbers for more info. Thanks in advance. --Dr. Fleischman (talk) 22:50, 24 September 2014 (UTC)

I have added links for a few so far that I found easily. However there are a few numbered citations in the article which reflect an earlier version, this early version where all citations were merely numbers, apparently where someone intended to add actual citations for each number. Some numbers were never replaced by citations. I am now changing those to "citation needed" tags. Otherwise, it would help if others could help find/develop the other citations. --doncram 19:49, 22 November 2014 (UTC)

Threshold issues

Jazz14, what's public HIV testing? What's live testing, and is there any difference? The article doesn't say. And can you please explain what this article is a about in a single sentence? Honestly I'm a bit baffled. --Dr. Fleischman (talk) 04:49, 25 September 2014 (UTC)

Recent changes

Doncram, no offense but I think you've really fudged up this article. Although it was so awfully written that it was difficult to understand quite what it was written about, I'm pretty sure it was about a special form of HIV testing (pioneered by Chittick) in which HIV testing was done in public, hence the "public" in the title. You seem to have added material about a different subject, what Chittick might call "private" HIV testing "of the public." So now we have an intermix of two different subjects. Am I mistaken? --Dr. Fleischman (talk) 08:08, 24 November 2014 (UTC)

DrFleischman, it was noted by yourself that it was unclear what the topic was or should be, and I have tried to clarify. Perhaps the article should be renamed to "routine HIV testing", or "promotion of routine HIV testing", where routine HIV testing is the widespread use of HIV testing in low-risk populations, as advocated in this New England Journal of Medicine article. The National HIV Testing Day is one notable effort in general support of widespread HIV testing that was not covered beforehand in Wikipedia, is now covered in this article. Chittick's organized "live" HIV testing events are another effort in support of widespread HIV testing, especially aimed at teens and at de-stigmatizing HIV testing. I don't like the term you used about what I have done. Perhaps you could positively comment on what you think the article was about and is about and should be about? --doncram 06:34, 25 November 2014 (UTC)

As I've said, I think the article was about a unique style of testing in public employed perhaps exclusively by Chittick. As such, it should be merged into the Chittick article. Now, if you wish to turn it into something else then I have no objection, but then I think the Chittick content should be removed. --Dr. Fleischman (talk) 10:13, 25 November 2014 (UTC)

Thanks. I expect you and I are not terribly far apart in our views, after taking into account that we are probably starting from different degrees of familiarity with the topic(s) and sources. As you will have seen, i've taken some time looking up references and getting a grip on what's covered in the existing article, starting by making current links to the online references where i could find them.

I guess I do think that the article should be broader than just the live public testing events run by Chittick. Rather the broader topic is promotion of widespread HIV testing, I guess. Promotion is itself a public health measure that, from what I read in links now in the article, is preventative of HIV/AIDS transmission...i.e. by increasing detection even in relatively low-risk populations, that awareness can lead to future transmissions being reduced. It seems like a strategy like for elimination of polio or smallpox or other diseases, where historically the best practices/strategies in public health have changed as prevalence of the disease changed and as costs and benefits of various treatments and so on changed; widespread HIV testing is now advocated by some scientists. Chittick is an advocate for widespread HIV testing among youths, who, with the live public testing events has what I think can be termed a "gimmick" that worked to gain some publicity. But the gimmick approach does not appear to be Chittick's TEENAIDS.ORG's main tactic; the organization seems to be about organizing and educating teens to peer-advise other teens (see Anna Beale interview with Chittick in which that is asserted). I think currently that the current coverage of Chittick and the TeenAids group in this article is too much, but that some reduced coverage is justified, in a article more broadly about the rationale and the tactics of achieving widespread HIV testing and major promotional efforts. I am inclined to broaden the article topic outside of U.S. too; there is a national testing day in El Salvador (see HIV/AIDS in El Salvador) and in other countries too i think. --doncram 14:33, 25 November 2014 (UTC)

By the way, I see at http://teenaids.org/past-events/worldrecord/ that a new intended-to-be-bigger event is scheduled in Norfolk VA on Dec 1. From this event or otherwise in the future there could be enough coverage of the live public "gimmick" style events for this to be a separate article on just that tactic, if there is more coverage and if there is actual controversy documented. The current article's assertions of controversy are not quite enough, IMHO; the accounts of dealing with some local government officials and with a world-records-certifying organization don't seem to be documented other than by the self-reporting from this organization. I currently feel more comfortable planning to include coverage of that in larger article about widespread HIV testing and its promotion.

Also by the way I see in Guidestar nonprofit 990 report filed for year ending June 30, 2014, that the organization had revenues of US $428k and approximately same expenses, up from approx. $39k revenue in year ending June 30, 2013. I also see mention at this Virginia-Pilot article from 2011 of the 1997-founded organization getting revenues of $76,000 in the 2008-2009 fiscal year, down from $40,000 the previous year. The organization seems significant, though not necessarily needing a separate article from Chittick article. The organization and Chittick don't just focus on the live event gimmick; that is not mentioned at all in 2011 article which covers Global AIDS Walks and a "Global Teen Webathon" with Facebook "pledges" campaign instead. These other approaches are worth mentioning in broader article.

Also by the way I see you participated in Wikipedia:Articles for deletion/Global AIDS Walks and that you are aware of the past speedy deletion of TeenAIDS-PeerCorps previous article. --doncram 15:00, 25 November 2014 (UTC)

I nominated it under G11 (like this article). --Dr. Fleischman (talk) 21:44, 1 December 2014 (UTC)

Broader topic of screening

(section title changed --doncram) Per my comments in section above, i think this article should be broadened to cover widespread HIV testing as a tactic and to cover promotion of that, and not just in the United States. There is missplaced material at Diagnosis of HIV/AIDS#Principles about anonymous testing and so on, that aren't properly part of an article that should be more focused on just the science/technology of diagnosis of HIV. And there's some more oddly placed material at Diagnosis of HIV/AIDS#Screening about S. Africa. Both can be merged here, leaving a link at the Diagnosis of HIV article. Here can cover the rationale for widespread HIV testing and history of it, e.g. CDC recommending "voluntary, routine testing of all Americans aged 13–64 during health care encounters" from 2006 on. And National HIV Testing days with free testing in U.S. and El Salvador and other countries. And promotional efforts such as Global AIDS Walks and the "live" public events and the Facebook campaigning and other efforts of Chittick and his group. --doncram 15:45, 25 November 2014 (UTC)

I'm not sure how you're getting that Diagnosis of HIV/AIDS should be only about the science/technology of HIV diagnosis. If you're thinking of turning this article into something about large-scale testing programs then it should be merged into that article, probably under "Screening." --Dr. Fleischman (talk) 18:54, 25 November 2014 (UTC)

Well, "diagnosis" as a topic is limited to, by one internet definition, the "identification of the nature of an illness or other problem by examination of the symptoms". Screening is different, it is "in medicine, is a strategy used in a population to identify an unrecognized disease in individuals without signs or symptoms. This can include individuals with pre-symptomatic or unrecognized symptomatic disease." So I happen to perceive the topic of diagnosis as more scientific-like, when I should perhaps have said "narrower" and/or termed it as dealing with an individual. Screening is a larger scale strategy in public health management, and is not naturally part of an article about diagnosis.

Hmm, Prevention of HIV/AIDS is another article to consider rationalizing in relation to Diagnosis of HIV/AIDS and the present article. The topic of prevention, like diagnosis, also seems to be primarily individual-focused, rather than addressing the larger public health level. There's some overlap: needle-exchange programs are mentioned within Prevention of HIV/AIDS#Social strategies; on one level needle exchange is a way for an individual to avoid being infected, and it also is part of larger public health. And i see AIDS, HIV/AIDS, and Epidemiology of HIV/AIDS as major related articles. Am I missing any? I am not sure where "epidemiology" should start and stop, but it does not currently really address public health management. Public health management including list of various strategies such as Chittick's seems to be what's missing? --doncram 20:54, 25 November 2014 (UTC)

--doncram 20:54, 25 November 2014 (UTC)

If you really want to turn this article into one about HIV screening in general then I think we should get a broad consensus first. --Dr. Fleischman (talk) 21:54, 25 November 2014 (UTC)

Okay i changed section title to add "screening" into it. I previously meant to include link to wikipedia article Screening (medicine) before. Google search on screening brings that up first, specifically: "Screening, in medicine, is a strategy used in a population to identify an unrecognized disease in individuals without signs or symptoms. This can include individuals with pre-symptomatic or unrecognized symptomatic disease." I think it is pretty clear based on definitions that "diagnosis" based on symptoms is different than "screening" when symptoms not apparent, and vice versa. And I think based on my review so far of Wikipedia articles, that HIV/AIDS screening is not properly covered anywhere yet, and I think there is plenty to say, and many sources, about screening programs. There can be legitimate disagreement about screening programs, including about whether WHO criteria listed at Screening (medicine)#Principles of screening are met. And there are instances such as South Africa one where screening was introduced then withdrawn. And I think Chittick's live public events are an example of promotion of screening. I feel this discussion back and forth has been helpful, but, now, why do you think a "broad consensus" must be obtained? Your yourself have opposed the existence of the article version focused narrowly. Are you now opposing it being framed more broadly? I'm not opposed to posting notice at various HIV/AIDS pages that this article is being edited to be about screening more generally. But, what would you be asking for, more specifically, in terms of seeking broad consensus? If you mean seeking community consideration of whether the topic of live public testing needs to be kept separate from a more general article about screening, then I don't support that. If you mean seeking community consideration of whether U.S. screening must be kept separate from a world-wide screening topic, I don't support that. So I would be happy to invite more participation in developing, but I'd rather just go ahead than seek permission, as I don't currently see what a broader community perspective could add. --doncram 16:36, 26 November 2014 (UTC)

I don't think we should be changing the subject matter of an article without first seeking community input, especially when based on the comments made at the AfD I doubt there would be consensus for it. --Dr. Fleischman (talk) 07:13, 29 November 2014 (UTC)

Okay, honestly I don't understand what you think others would have to say, but I am accepting your view that community input should be sought. I just posted messages like this one to the Talk pages of every commentator besides you and me in the AFD, inviting them to participate in this discussion about re-focussing the current article to be more about HIV screening in general. Also I am posting notices at Talk:Prevention of HIV/AIDS, Talk:AIDS, Talk:HIV/AIDS, and Talk:Epidemiology of HIV/AIDS, and Talk:HIV about this discussion. If you wish to seek community input in some other way, please proceed and/or advise, promptly. And, I'll pause for comments, but I expect to proceed in editing the present article to be less about Chittick's initiatives and more about HIV screening in general (which includes Chittick's initiatives). I don't believe anyone will object to this, but I am open to being surprised. --doncram 22:29, 29 November 2014 (UTC)

It looks like the "diagnosis" article was created by renaming HIV test in 2012. I couldn't find any discussion on the point, but WP:Be bold is a perfectly reasonable approach. I like the idea of re-creating an article about HIV screening, which is distinct from HIV diagnosis (and which is, in turn, distinct from Diagnosis of AIDS).

In fact, I think it might be appropriate to take these steps:

• Rename this to HIV screening (will probably require an admin) and change its contents to briefly discuss all medical screening for HIV everywhere, such as what the USPSTF recommends for all Americans, not just the "publicity stunt" types (which includes various celebrities or politicians being tested in public, as well as this outfit).
• Rename Diagnosis of HIV/AIDS to Diagnosis of HIV infection, because 99% of it is about detecting the (usually asymptomatic or at least non-specific) infection, rather than identifying the clinical point of AIDS.
• Make Diagnosis of AIDS the main title for that page, rather than AIDS-defining clinical condition, which needs a significant (but not large) expansion to properly cover the subject.

I can't commit any time to working on this myself before at least Christmas, but I think this would be a good approach. WhatamIdoing (talk) 21:01, 30 November 2014 (UTC)

What to do with this article ... since you asked

This article does not have a clear topical focus. The idea that "public HIV testing" is different from any other kind of HIV testing just does not work. The sections on Chittick are about a single person's campaign, and that is already covered amply in the article about Chittick. Everything else is HIV testing. Now, if someone wants to start an article on the history of HIV testing programs, that sounds fine. In terms of public health, the early programs, especially, were vital in slowing the spread of the disease - and there should be plenty of resources about that topic since many of the programs reported drops in new HIV infection rates in their area. These programs accomplished much more than Chittick's activities, which unfortunately have an air of "publicity stunt." The focus on "public testing" does not merit an article, and WP already has enough, if not too much, on Chittick's private campaign. LaMona (talk) 22:48, 29 November 2014 (UTC)

Thanks for replying. I think my intentions are not inconsistent with LaMona's comment. Per the above discussion section, I am wanting to revise this article to be that "article on the history of HIV testing programs", and to greatly lessen the mention of Chittick's activities. Sources to add and use include this Kaiser Family Foundation document "HIV Testing in the United States" dated May 02, 2014, and this CDC factsheet "HIV Testing in the United States", and CDC's "HIV Testing Trends in the United States 2000-2011" dated January 2013. I think Chittick can be mentioned briefly. Thanks, and further comments welcome. --doncram 05:06, 30 November 2014 (UTC)

Sensitivity and Specificity of Oraquick

Article states: The FDA allows the manufacturer to claim 99.9% accuracy for "negative" results but "positive" findings have a 91.7% accuracy rate due to the possibility of "false positive" results.[27]

This is incorrect. In fact it is the specificity that is 99.9%, i.e. the false positive rate is very low at 1 per 1000 truly negative individuals tested, comparable with other HIV screening tests. However, the the sensitivity is quite poor at 91.7%, with the screening test giving false negative results for 83 out of every 1000 truly infected individuals tested.

(I'd also add that the accuracy rate for negative results and the accuracy rate for positive results are the negative and positive predictive values respectively. It is not possible to calculate these based on the sensitivity and specificity alone - you also need to know the prevalence in the population you are using the test).

More generally, this is a curious article, and appears to have been created to promote a controversial campaign by a particular individual. It appears to have neutrality issues, and regardless of the merits of John Chittick's work is of doubtful notability for this encyclopedia - certainly a single and relatively brief article about who he is, what he does and why it's controversial would suffice. I'd have thought that an article entitled Public HIV testing in the United States would be about screening campaigns sponsored by public organisations, not about HIV testing done in public with the cameras rolling.

One other point - the lede describes Chittick as "a doctor" while the fourth paragraph says his qualification is Ed D - which is not a medical qualification. On A Leash (talk) 00:51, 30 November 2014 (UTC)

Thanks for replying. I agree also that this should be about HIV screening campaigns. Per previous two discussion sections, I intend to revise the article to be more focused on that, and to much reduce coverage of Chittick. Yes about your several points, including the important Ed D vs. medical doctor distinction there. I think my intentions are consistent with User:On A Leash's comments. Thanks, and further comments welcome. --doncram 05:09, 30 November 2014 (UTC)