Tests?

A September 2004, San Francisco Chronicle article considered the "beauty"
of testing. It told the story of 59 year-old veteran Jim Malone,  who'd
been told in 1996 that he was HIV positive. His health was diagnosed as
"very poor." He was classified as "permanently disabled and unable to work
or participate in any stressful situation whatsoever."

In 2004, his doctor sent him a note to tell him he was actually negative.
He had tested positive at one hospital, and negative at another.

Nobody asked why the second test was more accurate than the first (this
was the protocol at the Veteran's Hospital). Having been falsely diagnosed
and spending nearly a decade waiting, expecting to die, Malone said,  "I
would tell people to get not just one HIV test, but multiple tests. I
would say test, test and retest."

In the article, AIDS experts assured the public that the story was
"extraordinarily rare." But the medical literature differs significantly.

The Numbers

In 1985, at the beginning of HIV testing, it was known that "68% to 89% of
all repeatedly reactive ELISA (HIV antibody) tests [were] likely to
represent false positive results." (New England Journal of Medicine.
1985).

In 1992, the Lancet reported ("HIV Screening in Russia") that for 66 true
positives, there were 30,000 false positives. And in pregnant women,
"there were 8,000 false     positives for 6 confirmations."

In September 2000, the Archives of Family Medicine stated that the more
women we test, the greater "the proportion of false-positive and ambiguous
(indeterminate) test results."

The tests described above are standard HIV tests, the kind promoted in the
ads. Their technical name is ELISA or EIA (Enzyme-linked Immuno-sorbant
Assay). They are antibody tests. The tests contain proteins that react
with antibodies in your blood.

False Positives

In the U.S., you're tested with an ELISA first. If your blood reacts,
you'll be tested again, with another ELISA. Why is the second more
accurate than the first? That's just the protocol. If you have a reaction
on the second ELISA, you'll be confirmed with a third antibody test,
called the Western Blot. But that's here in America. In some countries,
one
ELISA is all you get.

It is precisely because HIV tests are antibody tests that they produce so
many false-positive results. All antibodies tend to cross-react. We
produce anti-bodies all the time, in response to stress, malnutrition,
illness, drug use, vaccination, foods we eat, a cut, a cold, even
pregnancy. These antibodies are known to make HIV tests come up as
positive.

The medical literature lists dozens of reasons for positive HIV test
results: "transfusions, transplantation, or pregnancy, autoimmune
disorders, malignancies, alcoholic liver disease, or for reasons that are
unclear..." (Archives of Family Medicine. Sept/Oct. 2000).

"[L]iver diseases, parenteral substance abuse, hemodialysis, or
vaccinations for hepatitis B, rabies, or influenza..." (Archives of
Internal Medicine, August 2000).

The same is true for the confirmatory test the Western Blot. Causes of
indeterminate Western Blots include: "lymphoma, multiple sclerosis,
injection drug use, liver disease, or autoimmune disorders. Also, there
appear to be healthy individuals with antibodies that cross-react...."
(ibid).

Pregnancy is consistently listed as a cause of positive test results, even
by the test manufacturers." [False positives can be caused by] prior
pregnancy, blood transfusions...and other potential nonspecific
reactions." (Vironostika HIV Test, 2003).

Inflated Africa Numbers

This is significant in Africa, because HIV estimates for African nations
are drawn almost exclusively from testing done on groups of pregnant
women.

In Zimbabwe last year, the rate of HIV infection among young women
decreased remarkably, from 32.5 to 6 percent. A drop of 81 percent
overnight. UNICEF's Swaziland representative, Dr. Alan Brody, told the
press that, "The problem is that all the sero-surveillance data came from
pregnant women, and estimates for other demographics was based on that."
(PLUS News, August, 2004).

Flawed Samples

When these pregnant young women are tested, they're often tested for other
illnesses, like syphilis, at the same time. There's no concern for
cross-reactivity or false-positives in this group, and no repeat testing.
One ELISA on one girl, and 32.5 percent of the population is suddenly HIV
positive.

The June 20, 2004 Boston Globe reported "the current estimate of 40
million people living with the AIDS virus worldwide is inflated by 25
percent to 50 percent." It said that HIV estimates for entire countries
have, for over a decade, been taken from "blood samples from pregnant
women at prenatal clinics."

But numbers about "AIDS deaths, AIDS orphans, numbers of people needing
antiretroviral treatment, and the average life expectancy" are all taken
from that one test.

I've certainly never seen this in a VH1 ad.

At present there are about six-dozen reasons given in the literature why
the tests come up positive. In fact, the medical literature states that
there is simply no way of knowing if any HIV test is truly positive or
negative:

"[F]alse-positive reactions have been observed with every single HIV-1
protein, recombinant or authentic." (Clinical Chemistry. 37; 1991). "Thus,
it may be impossible to relate an antibody response specifically to HIV-1
infection." (Medicine International. 1988).

Ambiguous Results

And even if you believe the reaction is not a false positive, "the test
does not indicate whether the person currently harbors the virus."
(Science. November, 1999).

The test manufacturers state that after the antibody reaction occurs, the
tests have to be "interpreted." There is no strict or clear
definition of HIV positive or negative. There's just the antibody
reaction. The reaction is colored by an enzyme, and read by a machine
called a spectro-photometer.

The machine grades the reactions according to their strength (but not
specificity), above and below a cut-off. If you test above the cut-off,
you're positive; if you test below it, you're negative. So what determines
the all-important cut-off? From The CDC's instructional material:
"Establishing the cutoff value to define a positive test result from a
negative one is somewhat arbitrary." (CDC, 2003)