Diagnostics and mandatory reporting
The diagnosis of “HIV infection” has considerable consequences for those affected, whereby not only psychological and social consequences but also legal (e.g. insurance law) aspects must be considered. Due to the importance of an HIV diagnosis (even if it turns out negative), there is agreement in Germany that, in accordance with the recommendations of the World Health Organization, it may only be carried out in conjunction with detailed information and advice before the test and after the test result has been communicated. In any case, the express consent of the person examined is required, otherwise the conduct of the examination can be assessed as bodily harm. This procedure can only be deviated from in a few exceptional situations, for example. Note: according to AbbreviationFinder, HIV stands for Human Immunodeficiency Virus.
The HIV antibody test is established as a routine test in the form of an ELISA, with which antibodies directed against HIV can be detected in the blood during or shortly after the seroconversion disease (at the earliest after 4, in more than 95% of the infected about 12-16 weeks after a possible Infection). Since other diseases can also lead to a supposedly positive reaction in the HIV antibody test, a confirmatory test (usually as a Western blot; blotting) required to rule out the first false positive test results. HIV antibody tests have a high sensitivity and detect antibodies against HIV in more than 99%, which means that false negative test results in which the test does not show an antibody reaction even though an HIV infection is present are very rare. Both HIV-1 and HIV-2 are detected using standard tests.
Even rapid tests using antibody technique. Their name refers to the fact that with them the test result is available faster than with conventional antibody tests from the blood, but the time between a possible infection and the diagnosis is not shortened. In a small number of infected people, it can happen that the formation of antibodies occurs too late or does not occur. This creates a diagnostic gap for diagnostics with the HIV antibody test. B. Detection of the p24 antigen of HIV, nucleic acid detection or polymerase chain reaction (PCR), can be shortened by 2-4 weeks. While p24 antigen diagnostics are also routinely used with blood donors, PCR is only used in individual cases as qualitative diagnostics for the detection of HIV infection, e.g. B. in children of HIV-infected mothers, because they have maternal “loan antibodies” which are transferred from mother to child during pregnancy and can no longer be detected after about 12 months.
A detection of antibodies against HIV, of HIV itself or of virus components is not to be equated with the diagnosis of “AIDS”. To assess the state of health, to assess possible disease risks or to weigh up whether treatment is necessary, in addition to any further laboratory tests, v. a. a clinical examination and an overall assessment are required.
There are a large number of different reporting and recording procedures around the world with which HIV infections, AIDS diseases or AIDS-related deaths are recorded. The Europe-wide recording of HIV and AIDS is carried out by the European Center for the Epidemiological Monitoring of AIDS. In Germany, HIV infections must be reported anonymously to the Robert Koch Institute (RKI) in Berlin by the diagnosing laboratory or doctor. The legal basis for this reporting requirement was initially the Laboratory Report Ordinance of 1987, which has been replaced by the Infection Protection Act (IfSG) since 2001.. In addition, an AIDS case register is kept at the RKI, in which all patients who develop the full picture AIDS are to be recorded; here the report is voluntary. In Austria, the AIDS Act has regulated the reporting obligation for all AIDS cases and deaths since 1986. In Switzerland, AIDS cases must be reported to the Federal Office of Public Health on the basis of a federal reporting ordinance. The laboratories report positive test results anonymously.
Social and political reactions
AIDS solved v. a. at the beginning of the occurrence sometimes shock-like reactions. The belief that modern medicine had finally brought infectious diseases under control was permanently shaken. Uncritical projections of the initial HIV spread calculated z. B. for Germany with several million infected people within a few years. Since AIDS as a disease was closely linked to taboo areas such as (homo-) sexuality and drug consumption and those affected and at risk were (and are) widely stigmatized as marginalized social groups, in Germany too there arose tendencies towards exclusion and demands for coercive measures, fueled by irrational fears of infection were not realized after sometimes violent socio-political disputes.
An important goal of HIV prevention is therefore also the promotion of a socially integrative, affected-friendly social climate in which voluntariness instead of compulsion is the drive for individual behavior changes. Close cooperation between government and non-governmental organizations is also an essential basis for successfully containing the spread of HIV. In 1987 the federal government initiated the “immediate program to combat AIDS”, which v. a. Prevention, education and training, HIV test counseling and research included. The National AIDS Advisory Board was set up as an expert body at the Federal Ministry of Health. The Bundestag appointed a commission of inquiry (“Dangers of AIDS and effective ways to contain it”), whose final report (1990) contributed to the objective discussion of the strategies for combating AIDS. AIDS center set up in the Robert Koch Institute.
The self-help movement organized v. a. in the USA and Europe also their socio-political presence. Here, those affected and at risk exerted influence on government decisions and scientific programs. The inclusion of those affected in prevention programs, medical studies and social policy measures was also a constructive impetus for other health and social policy areas through the AIDS self-help movement. In addition to the AIDS charities, the German AIDS Foundation is committed to providing social and material support for those affected. The age structure of the sick (around 70% are younger than 45 years) leads to v. a. due to the lowest pension entitlements, to a very poor material situation. Due to the deficiencies in the HIV safety of blood and blood products identified by a parliamentary committee of inquiry in the 1980s, the foundation “Humanitarian Aid for People HIV-Infected by Blood Products” was set up in Germany by the HIV Aid Act in 1995.
In contrast to Germany and many western industrialized countries, the HIV epidemic has led to social and economic destabilization in numerous countries in Africa and Southeast Asia, as the economically most important groups of the population are sometimes hardest hit by AIDS. In 2001, at the suggestion of UN Secretary General K. Annan the “Global Fund to Fight AIDS, Tuberculosis and Malaria” set up to intensify prevention and improve treatment options; there are also other initiatives, for example supported by the European Union or large commercial enterprises. With the “3 by 5” program, the World Health Organization pursued the goal of giving 3 million people worldwide access to antiretroviral therapy by 2005. It was a very ambitious goal that could not be achieved in the targeted timeframe. It became clear that such programs can only be financed through the use of inexpensive, unpatented drugs. At the same time, it is necessary to set up a medical infrastructure in the affected countries.
Basically, there is now agreement that the HIV epidemic can only be countered through global cooperation.