Low Rate of Testing
To help address the low rate of testing and high rate of
concurrent AIDS diagnoses among New Hampshire residents, New Hampshire
should adopt mandatory HIV and STD testing for all individuals wishing
to attend college in the state of New Hampshire. College students are
prone to engage in risky behavior, not be in mutually monogamous
relationships, have numerous partners, and have use condoms
inconsistently. All of these factors increase an individuals chances of
contracting HIV (4).
Research has been done indicating that college freshmen who attend an AIDS education program are more likely to have an HIV test done while at school and use condoms. These students were also more likely to ask a partner about his or her sexual history and ask a new partner to be tested before having sex (5).
Knowledge about HIV alone isn't enough to encourage safer sexual practices. College students tend to be well informed about HIV/AIDS, but they don't feel that they themselves are at risk. This may account for why college students repeatedly ignore public health warnings concerning condom use (6).
One way to personalize the risk for HIV infection is through HIV antibody testing. Individuals tested for HIV antibodies showed a decrease in unprotected vaginal and anal intercourse (7). Also, these individuals were more likely to question partners about their serostatus. Individuals who know their own serostatus may be more comfortable questioning the serostatus of a future partner (8).
Requiring all individuals to be tested for HIV and STDs before entering college in New Hampshire would likely decrease the HIV incidence among this population. Individuals infected with STDs are more likely to contract HIV (9). Requiring students to be tested for STDs would give those infected the opportunity to be diagnosed and treated. College women who reported having a history of five or more partners and inconsistent condom use had an STD rate of 25% compared to only 2.5% in women with a history of one or two partners and consistent condom use. (4) Pre and post test consoling as part of the HIV testing would allow these individuals at a higher risk of contracting STDs and HIV to be counseled about safer sexual practices. Also, testing has been shown to reduce risky sexual behavior (10).
The majority of college students are sexually active. 74.3% of college men and 68.9% of women have reported participating in sexual intercourse at least once (4). College students who live with roommates or by themselves tended to be more sexually active than those who lived with family (4). Because individuals are likely to be sexually active once at college, requiring that students to be tested before entering college allows for them to be treated before infecting others in the college community.
Theoretically, under this program, everyone entering college would be aware of their serostatus and STD status. Individuals who have been tested for HIV are more likely to question partners about their serostatus before engaging in sexual activity (8). Students would also know that fellow students should know their status. This knowledge, in theory, would help facilitate a discussion of history and HIV status before sexual activity took place.
Exposing individuals to HIV/STD testing hopefully will reduce the stigma attached to having a test done and increase the likelihood that they will be tested in the future. Introducing this behavior in a college community setting when individuals are likely to be responsible for their own health care for the first time in their lives would hopefully increase the chance of them continuing to be tested later on in life.
Physicians as well as the general public generally support mandatory HIV testing. 63% of Americans and 64% of physicians surveyed responded that they believe that requiring mandatory HIV testing would improve the health of the general population. 60% of the population and 59% of physicians surveyed indicated that the benefits associated with mandatory, federally funded HIV testing would outweigh the social implications associated with mandatory testing (11). Shifts towards eliminating the exceptionalism associated with AIDS public policy are already starting to occur. The CDC has just recently issued new guidelines extending routine HIV testing to the entire population and is reconceptualizing the issue of consent. Instead of requiring patients to sign forms giving their consent to HIV testing, doctors will now inform the patient that they will be doing an HIV test, then ask if they have any questions. In contrast to the past, the CDC now believes that general consent to medical care includes consent for HIV testing (12).
Although this program would require students entering college to be tested for HIV and STDs, it would not require that the results be reported. There would just be a check box for the health care provider to indicate that the test had been performed. This way, the benefits of testing college students would be achieved, without getting into the privacy concerns associated with reporting an individuals HIV status.
Most states already have requirements that students be vaccinated against a multitude of diseases and infections before entering college. Among the things that various colleges and states require entering students to be vaccinated for are measles, mumps, and rubella, diphtheria, tetanus toxoid, polio, chicken pox, hepatitis B, hepatitis A, and meningitis. In addition to the vaccinations, most entering college students are required to be screened for tuberculosis (13). All of these diseases are contagious and would pose a serious threat to public health if they became an epidemic. HIV and STDs are no different, and HIV and STD testing should be required for students attending college in the state of New Hampshire.