Testing the HIV Testing Mantra

Early in my Johannesburg years, I used to have regular coffee chats with Dr. Francois Venter, president of the Southern African HIV Clinicians Society. Over cappuccinos (we both had serious caffeine addictions), we'd talk about how to save the world from AIDS. More often than not, we'd scheme about how to get everybody tested for HIV. It seemed like a natural triple-word-score of AIDS progress. If everybody knew who was infected, stigma would go down. The sick would seek treatment. And everybody would be more careful.

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Well, seems we were wrong, at least about that last part.

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Dr. Venter and I were hardly the only ones mulling those issues at the time. The picture above shows Randall Tobias, the former Bush Administration Global AIDS Czar (before his fall from grace) getting an AIDS test to publicize the importance of the issue. Former President Clinton has talked up testing endlessly. So has Richard Holbrooke, and many, many others.

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What we all missed was that while testing does indeed help people seek treatment, and likely eases stigma because the extent of HIV infection is clearer to all, there's little meaningful evidence that people who get tested act safer in the long run. In fact, the opposite may happen.

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Several studies, both in Africa and among the U.S. and U.K. gay communities, suggest that measures of safe behavior often deteriorate for those who test negative for HIV. Not knowing your status, it seems, inhibits certain kinds of reckless behavior, such as multiple partners, visits to prostitutes and sex without condoms. Knowing for sure that you are NOT infected, meanwhile, can do the opposite. It can validate past behavior, including risky behavior. It's like a smoker finding out they don't have lung cancer... yet.

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The good Dr. Venter gently broached this subject in a recent conference in South Africa, suggesting that the testing mantra is overdrawn. Kudos. The groupthink on this subject has gone on far too long. Kudos also to my co-author Daniel Halperin, who pointed out to me the limits of HIV testing a several years ago, allowing me to get off the bandwagon earlier than most. Here is his 2007 op-ed piece in the Washington Post about this.

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Nobody, of course, is suggesting that getting tested for HIV is a bad thing. It's a good thing. But let's not confuse something that is good for the individual (who may now seek treatment) with something that has the power to slow the spread of AIDS on a broad, society-wide level. The list of those things, sadly, is rather short.

Craig Has Landed Back at the Post....

Regular readers of this blog (and my Tweets and Facebook updates) may have noticed that I vanished from cyberspace about three weeks ago. The reason was a fateful call from The Washington Post that has led to my becoming Education Editor, after a decade as a reporter there. No one is more surprised--or thrilled, or surprised that I'm thrilled--than I am. But the shift has been so abrupt that some explanation may be in order.

First, I'm still working on my book project with Harvard AIDS researcher Daniel Halperin, and given that I don't have to show up at the Post newsroom until my book leave ends in early September, we have three months to complete at least an initial draft of the manuscript. Second, my interest in all things about AIDS and Africa is undiminished. I still obsess about Zimbabwe, South Africa, Nigeria, and whether all the billions being poured into the AIDS War are being used well. This blog will continue to discuss those issues.

But my unexpected discussions with the Post's new Local Editor, Emilio Garcia-Ruiz, awakened something in me that I was trying to ignore: American newspaper journalism is in grave trouble, and I was on the sidelines in the battle to save it. I watched the Tribune Company hack two-thirds of the muscle out of the newsroom of The Baltimore Sun, my father's longtime professional home, and lay off my extraordinarily talented brother, Scott, from the Los Angeles Times (despite a run of good evaluations). So the personal stakes were certainly clear to me.

Yet even more I worried that the loss of our newspapers meant the loss of a shared narrative about our nation. The best papers are the daily diaries of their communities, and having lived and traveled in parts of Africa that lacked strong newspapers, I could see what happened when citizens and their leaders didn't agree on even the most basic elements of what was happening in their societies.

All papers, even the best ones like the Post, surely have failings but for decades they have been places where we meet, we talk, we chew over difficult issues, we exult in human achievement and lament human failing. Maybe cyberspace is becoming that, but from here it seems to created ever-more fractured conversations as it empowers new voices, diminishes others, and spins continually outward into new terrain. The center does not hold. Even the idea of the center--a place where straight-up news gathering is regarded as something akin to a calling--is feeling more quaint and antiquated by the day.

Offered the chance to rejoin a newsroom that's trying to save something so dear, I leapt at it with my usual manic fervor. That's why I've been out of touch for awhile. As one of my new editor colleagues said to me: "If we're going to go down, we might as well go down fighting."

Hell yeah!

That doesn't mean that the Post is in imminent peril. By most measures, the Post is the healthiest of the major American newspapers. Yet there's no ignoring that if we don't figure out how to make real money on the web, all newspapers are doomed.

I did, in applying for this job, gently mention to my new boss Emilio that I had virtually no background in either editing or education. But I also once knew nothing about Virginia politics, or D.C. politics, or AIDS, or any number of African nations. And I did already have a sense that schools and universities are so central to our societies that they should be a continuous source of great journalism, even if they have not always been so in the past.

As I began to assess my new team of reporters, it quickly became clear that the Post had a deep stable of talent ready to push harder and deeper into the subjects our readers care about. Probably the most difficult challenge we face will be mastering the new journalistic forms that the the web makes possible and, for those news organizations that survive this transition, ultimately demands of us.

So that's what's happening. I'm becoming an editor after 16 years as a reporter, foreign correspondent and (fingers crossed) an author. I can't think of anything right now that sounds more fun, or more important.