Read the article below, "Fighting HIV a Community at a Time." , answer the following questions. Please type your answers...complete and thoughtful responses...1/2 page, single spaced minimum.

1. Statistically as many as 20-25% of people who are HIV positive do not know they are infected. Why do people not get tested if they engage in risky behaviors (unprotected sex and/or IV drug use with used needles)? Give reasons and rationales for their decision not to get tested.

2. In 2006 only about half of Washington D.C. residents who were tested positive for HIV saw a doctor about it within 6 months. They are contagious during that time. Again, why would someone who receives a positive diagnosis, not get treatment? Is a diagnosis of HIV different from other STDs? Why or why not?

3. The "test and treat" program in D.C. and the Bronx improved the follow-up of prompt medical care. What are the statistics?

4. At the end of the article, it states the profile of who is most resistant to being tested and treated. What is it about that particular group of people that would make them resistant?

Fighting HIV a Community at a Time Susan Okie, New York Times, Oct. 27, 2009

WASHINGTON- Federal health officials are preparing a plan to study a bold new strategy to stop the spread of the AIDS virus: routinely testing virtually every adult in a community, and promptly treating those found to be infected. The strategy is called "test and treat," and officials say the two sites for the three-year study will be the District of Columbia and the Bronx--locales with some of the nation's highest rates of infection with HIV.

The officials emphasize that this is just a first step. The goal is not to measure whether "test and treat" actually works to slow and epidemic, but whether such a strategy can even be carried out, given the many barriers to being tested and getting medical care.

On the path from infection to treatment, "we lose people at every single step," said Dr. Shannon L. Hader, director of the HIV/AIDS administration at this city's Department of Health.

As many as 5 percent of the adults in the District of Columbia are infected--a rate Dr. Hader says is comparable with those in West Africa--and one-third to one-half do not even know they harbor the virus. (Nationwide, 20 percent to 25 percent of people who are HIV positive do not know of their infections, according to the federal Centers for Disease Control and Prevention.)

And even when infection is diagnosed, "getting people from the field to the doctor is the hardest component," said Angela Fulwood Wood, deputy director of Family and Medical Counseling Service, and agency that operates a mobile HIV testing clinic here. Often, she added, someone who has just tested positive "can walk off that day and decide, ‘I'm going to pretend that never happened.' In 2006, only about half of D.C. residents who had a new diagnosis of HIV saw a doctor about the problem within six months.
The C.D.C recommends routine, voluntary HIV resting for everyone ages 13 to 64 as a part of regular medical care. But experts say the recommendation is not being followed in many hospitals, clinics and medical practices. Even when doctors do offer the test to patients, "A significant number refuse," said Dr. Anthony S. Fauci, director of the National institute of Allergy and Infectious Diseases, which is to pay for the test and treat feasibility study.

Dr. Fauci said testing might also be widely offered in nonmedical settings. "When you have a campaign like this, you've got to pull out all the stops," he said. "How are we going to get everybody? Should we have testing in Wal-Mart?"

The test and treat approach is part of a broader shift toward using medicines for HIV to prevent the viral load from increasing. When an infected person starts taking one of the standard three-drug regimens, the level of the virus in blood and other body fluids drops rapidly, often to undetectable levels.

Current treatment guidelines do not call for antiretroviral drugs until there is evidence of progressive damage to the immune system--generally, until the number of CD4 (or T4) cells, the white blood cells attacked by the virus, drops to 350 per milliliter or lower. (A normal count is at least 1,000 and an AIDS diagnosis is partially made when the count drops to below 200).

The guidelines are intended to balance the treatment benefits with the side effects from the drugs and the possibility of fostering drug resistance in the virus. But there is mounting evidence that early treatment keeps infected people healthy longer.

So far, however, despite some ambitious efforts, no city or country has come close to achieving universal testing for HIV and treatment for all those infected. But researches and public health officials are eager to test the potential of such a strategy for stemming the epidemic.

In low-income neighborhoods in Washington DC, some people are reluctant to start treatment, said Ms. Wood, whose HIV testing program and clinic is based in Anacostia, a community in Southeast D.C. that has long had high rates of drug abuse and HIV infection, as well as a shortage of health services. Early HIV drugs had multiple side effects, including fat deposits on the upper back that created an unsightly hump. "People saw that when others started taking the medicine, they seemed to get worse," Ms. Wood recalled.

In the District of Columbia, heterosexual sex is the most common mode of transmission reported by patients with newly diagnosed HIV. Researchers say that makes the city a strong candidate for test and treat, because the strategy is likely to be more effective in preventing spread among heterosexual than among drug abusers or men who have sex with men.

Health officials in both Washington D.C. and the Bronx are already in the middle of campaigns to promote HIV testing and increase the number of new patients who get prompt medical care. In the first year of a program called Bronx Knows, begun in mid-2008, 70 percent of residents with a confirmed positive HIV test were sent to doctors and clinics for care, Dr. Sweeney said.

In the District of Columbia in 2006, only 50 percent of those with new diagnoses of HIV saw a doctor for the problem within six months. Community outreach workers who perform testing are now being retrained to focus on getting their clients into treatment.

"If you're doing HIV testing, your job doesn't end with just telling the individual their test results," said Dr. Hader, of the district's Health Department. At a neighborhood fair a few weeks ago in Oxon Run Park in the southernmost corner of Washington, a worker passed a basket of condoms among the crowd waiting in line for hamburgers, while announcements over a loudspeaker urged attendees to visit Family and Medical Counseling Service's mobile HIV testing unit, inside a brightly painted trailer parked under trees.

Community testing programs are likely to attract people who suspect that they might have contracted HIV. But Ms. Wood said the key to test and treat would be capturing those who did not volunteer for testing because they did not believe they could be infected. In other words, "People who are promiscuous at college, the partygoers, the young professionals who go to the clubs," are less likely to believe they could be infected by their unsafe behaviors.

"Offering routine testing at either emergency rooms or physicians' offices." She continued. "I think that's our biggest chance of really catching people earlier."