testing today is rather simple it’s it’s pretty similar to what we had since 1986 or so a blood sample could be tested for the presence of absence of antibodies to HIV first thing we do is a screening test which is very sensitive but anytime you screen large numbers of people particularly low-risk people you always get a certain number of false positives if one would test positive then one would do a so-called confirmatory test it’s also looking for antibody by using a most specific technique the important thing in screening is to use one test to pick out the people who are probably infected and then a second test call a confirmatory to be sure that you’ve got the right ones and it’s also important that they be done using different technology so in the case of HIV screening we use one kind of technology called the Eliza for screening and another kind of technology all the Western blot to confirm why is the Western blot considered at least for now the gold standard the Western blot is considered as the gold standard because it it is a very specific test based on the criteria that are established by expert organizations a certain profile will indicate infection in the hundred percent of the cases so that if we use the Western blot and we look at the profile that’s produced the antibody reactivity against certain antigens or proteins of the virus that profile is found to be accurate 100 percent of the time or nearly 100 percent of the time when that profile is present so the western blood is the gold standard in the sense that we can we can judge and and base our estimate or predict whether a person is infected to a high degree based on that profile now you kind of touched on it but can you just tell me what exactly the term gold standard is a very difficult term to to actually define what it actually means is the best test of the best measure we have currently available whether that measure be growing the virus to confirm that somebody’s infected however gold standards by themselves aren’t necessarily 100% accurate in fact there are no gold standards that are really 100 percent accurate there’s always exceptions but a gold standard is the best test we have in which to compare a new method you the scientific literature clearly shows that there are about 70 different conditions that can cause a false positive HIV test and some of those conditions are quite common this is from infectious disease clinician of North America 1993 human or technical errors other viruses and vaccines have you ever had a flu shot archives of internal medicine August 2000 liver diseases parenteral substance abuse drug abuse hemodialysis or vaccinations for hepatitis B rabies or influenza it’s from the journal transfusion in 1988 unpasteurized cow’s milk bovine exposure or cross reactivity but other human retroviruses renal failure liver disease blood transfusions syphilis and malaria autoimmune diseases are notorious for interfering with some of these tests and perhaps producing a false positive result you can test positive if you’ve been exposed to the tuberculosis microbe or not just if you’ve got TB but if you have a friend a close contact who’s got TB hyper gamma globulin emia it just means increased

levels of anybodies in general pregnancy which is well known which is false positive test too many antigens multiple blood transfusions is another one any reason to get false positive Western blot tests archives of internal medicine August mm causes of indeterminate blot western blot tests include lymphoma multiple sclerosis injection drug use liver disease or autoimmune disorders also there appears to be healthy individuals with antibodies that cross-react the Western blot is not used as a screening tool because it yields an unacceptably high percentage of indeterminant results it is true that there’s many publications in the literature that speak of false positive test results on HIV tests due to a multitude of different factors however I want to emphasize that the term false positive is really a misnomer because there is no test for HIV so if we can’t say what sample is truly infected and which one is not infected then how can we judge whether or not another test is scoring falsely positive or truly positive the specificity of these tests have not been scientifically evaluated and thus sure being done before they are introduced into clinical practice you you good afternoon ladies and gentlemen the probable cause of AIDS has been found credit must go to our eminent dr. Robert Gallo who directed the research that produced this discovery what was new that day is for the first time we were saying that’s the cause I’m sure and we have a blood test that will protect him let’s up like tomorrow once we got away from the screening blood to actually trying to diagnose people we were able to use screening tests the early way that was done in the 80s was they took the virus they grew it up and some cells and they took that Ganesha cells and virus and put it down into an assay just and so it had all the normal cell material and all the pieces of the virus and if when you added serum from human beings in that serum was antibody if it recognized any of the cell Ganesh or any of the viral proteins it would bind and get a reactive test so the the original lies is in those days and many of these screening tests could only tell if you had a reaction to any of the commission or or to the virus itself couldn’t tell which it was the first test developed by Bob Gallo and his colleagues at NIH was quite inaccurate I think the about this was not very specific at the beginning for example the Defense Department if you were reacted by the screening test and a low-risk population joining the military two-thirds of those people were really not HIV infected but today the iliza type assays have greatly improved in their percentage of accuracy and are somewhere up in the 99.99 you know percent range it’s very very high the test is 99.9% accurate but for what the question is for what this is from the New England Journal of Medicine in 1985 the beginning of the HIV testing it was known that 68 to 89 percent of all repeatedly reacted HIV antibody tests were false some 70 to 90 percent at the beginning they only used the Aliza and we were worried for a while because we felt certain data backup was necessary as a consequence we got in the habit in the u.s. of every time you got a positive result with an Eliza si you would then do a Western blot which was a more precise more expensive more difficult test to confirm it so you’d have some certainty that that you were getting a you know a meaningful result then if they both came positive in 92 The Lancet reported that for 66 true positives there were thirty thousand false positives and in pregnant women quote there were eight thousand false positives for six confirmations 1996 in Journal of the American Medical Association the diagnosis of HIV infection in infants is particularly

difficult because there’s no reference or gold standard that determines without doubt the true infection status of the patient in 2000 the Journal of AIDS reported that either 2.9 percent or 12 point 3 percent of women in this in their study tested positive quote depending on the test used but since there was no established gold standard test it’s unclear which of these two proportions is the best estimate of the real prevalence rate no I think they are really good tests really accurate very sensitive everywhere no state in France in Europe everywhere and they are also happy tests it analyzes positive it does not mean that the patient is HIV positive that’s a problem I don’t think the Western blot is a useful diagnostic test I don’t think it’s worth doing you can go to other centers and boil test and verify you cannot see the Hamilton it was fine plans hurry from area to area do these tests and they come with stories that I was negative at the Salem area and positively see how do they decide whether they’re positive or negative we cannot tell because we are using a repetitious it’s interesting to see how the language has changed in the manufacturers test kits over time in 1994 Abbott Laboratories States the ideological agent or the causative agent of AIDS is a retrovirus called HIV by 1996 they have changed this language to state epidemiological data suggests that AIDS is caused by HIV more recently a manufacturer of a rapid test kit called Ora quick states acquired immunodeficiency syndrome is thought to be caused by the human immunodeficiency virus and then even more recently the manufacturer of another Eliza States published data indicate a strong correlation between AIDS and a retrovirus referred to as HIV so you can see the language has been loosening up in these package inserts as time has been progressing in some tests for example from one non company in the United States which actually produces the most widely sold eliza test they state that beside the test being very reliable they state there is no recognized standard to establish the presence or absence of an a of HIV antibody seen in human blood I’m not a technician but I wonder what that means if the company who is producing and selling the test is not even aware of how to verify their the reliability of their tests by admitting no one in the world according to their knowledge has any risk established a recognized standard to verify whether their test is reliable or not just to give you a very stupid example if I would use a pregnancy test and the package insert of the pregnancy test would say this is a very reliable pregnancy test but there is no recognized standard of establishing the presence or absence of a pregnancy I would be kind of reluctant to use the test and I would wonder why the company selling in the test a test when they can’t verify how reliable it is and of course their means and ways to verify presence absence of a pregnancy we have a gold standard so we can verify whether test is reliable or not and obviously at least the main the main company in the word producing and selling these HIV tests is not aware of a recognized standard I find the troubling from a clinical point of view some people argue that that we have a confirmatory test in some parts of some Western countries and that repeated testing can lead you to a safer diagnosis but if the very basis of the test is 40 then nothing works in fact the confirmatory test is a bit more sophisticated in which you take the virus and you break it up into with different components and you put it on a strip that separates the different components and it’s called a Western blot so the Western blot actually looks at bands of the proteins when there is

an interaction of the antibody with the viral protein in question let’s say the viral protein that’s called p24 or the envelope we call gp120 when you see bands lighting up well those are surely the viral proteins because they’re scoring of exactly the size that we know the viral proteins to be and you only see those bands when the antibody has interacted with them when you’re looking at this this western blot how do you determine what is a positive you need a certain number of bands being present it depends a little bit on the producer of the test it depends on the manufacturer is you is there different criteria for what might be a positive yeah there are different criteria from the manufacturer thank you for the word and also there are guidelines from the whu-oh and you Nate Claudia showed me the package insert that comes with the Western blood it contains eight different sets of criteria for diagnosing HIV infection because of the different criteria that apply in different countries you couldn’t be considered you can test hiv-positive in one country and be given an AIDS diagnosis as a result of that whereas in another country you won’t test hiv-positive and you won’t be given an AIDS diagnosis so ludicrous that you can be positive in one country and not positive in another this is where the argument was early on is how you define criteria the early days beak people actually develop criteria that were too much like a screening test so if you had just p24 and they might have cause to call it a positive many people were diagnosed using these criteria and then it was realized that 40% of people have they were completely healthy have one or more Western blot means most commonly a p24 band we don’t know how many thousand people were tested using the Western blot that Western blot criteria before 1987 but it invites the question shouldn’t they all be tested soon they’ve all been tested when the criteria changed after 1987 in case they were no longer possible because after 1987 that wasn’t good enough to make you HIV positive so they’re probably people out there who would not be positive on the criteria which developed subsequently P 24 or P 41 or both and people were diagnosed just with one people had to learn how to what’s the right criteria for reading Western blots if you actually go back and look at the document over time those criteria changed up into 1993 the FDA criteria where a like a protein van plus P 24 plus P 32 they actually specified what the bans were now using the FDA criteria which existed before 1993 only 80% of AIDS patients had a positive test that is though a positive Western Bock test which means that 20% were not positive on the FDA criteria 80% tested positive 20% didn’t on the FDA criteria okay in 1993 the FDA changed their criteria they dropped the need to have P 32 they had more positives on the FDA criteria there are more positive tests the FDA criteria was said to be the most specific but they weren’t the most used the CDC criteria are the most used in the United States which means that people were not tested in the United States using the most specific test there are specific criteria for interpreting Western blood results and specifically if you don’t have the three bands the three major HIV bands in 24 gp41 and gp120 160 then it still would not be a positive result the one we’re using here is where we have at least two or three major bands appearing in here and at that point we’ll call it a positive most people that are infected most people will have a full profile against

all the viral components in order to limit the number of false positives how come they don’t just in terms of the Western blot how come the criteria isn’t just all 9 proteins if you react with the online proteins in your positive how can let’s only limit it to three I don’t know the answer to that it’s probably cuz they’re harder to see on some of the other bands that are overlapping with some other proteins but I don’t know in an effort to make the Western bun a little more specific do you think we should maybe up the bands to like for crack-whore or fire there’s constant discussion in the community of people who do diagnostic testing in the blood bankers about how to read these tests and you can get together a group of people and they may or may not agree so all these tests are read in a way that we think is the optimal reading but it’s not ever going to be perfect I don’t think the Western blot is a useful diagnostic test I don’t think it’s worth doing but it’s a useful prognostic test once you know that someone is infected then you can follow their antibody responses well with Western blots you’re looking forwards into how the patient’s get to do in the future in a prognostic test diagnosed say is the patient infected or not you don’t need a Western philosophy and it’s become a Dogma in HIV research so you need one eliza followed by a Western you don’t you need two different kinds of Eliza’s made in two different formats Western blots have been sort of promoted into some sort of Holy Grail this has a margin of error done properly that’s extremely low in other words it’s one of medicines better tests if the Western blot is such a great test isn’t it used in England when Philip Moldova who’s the director of the national reference laboratory in the United Kingdom says that it remind began and and should have remained a research tool so you ask some of your experts in the United States if such a great taste how come the English don’t have to use it I don’t know I can’t comment about that cuz I’m not really sure what why they did that oh I’d hate to make a comment about in another countries practice when I’m not really sure we have a group now about 40 patients that have no detectable virus in their body but they’re not being treated so the first question is are they really infected so the Western blots can have false positives no the Western blot was negative too but they were told they were positive by a lab yes that misread the Western blot there are other proteins in the body that sometimes react and cross reacts so that when you take the antibody from a normal person who doesn’t have any antibody to HIV and you allow it to react either in the ELISA or in the Western blot you may see an nondescript indeterminant band that could be a false positive test for HIV if one person interprets western blood differently than another person that sure will change the specificity of the test if you’re calculating how many times was the test right or wrong but somebody’s reading it wrong all the time then the test is going to look much worse than if somebody else had read it correctly so technical errors subjectivity all these things to come into account and and to looking at the true utility of a test or its value it in Australia you need four particular bands to have a positive Western blot so if you have three it’s not positive okay but when you get the fourth band it is positive which means all those bands are due to genuine HIV anybody’s but if you only have three they’re not due to generation of those so why is it adding the fourth one it makes the other three genuine I mean it’s a it’s a puzzle isn’t why can’t the fourth Bend be non HIV as well walk out all the band’s been on HIV since a false positive looks like a true positive how can you ever distinguish whether it’s truly a positive or a negative well that’s a great question now it’s gonna be very hard to determine a false positive heavyweight champion Tommy Morrison tested positive in 1996 11 years later in 2007 he tested negative multiple times allowing him to return to the ring

the most important thing this whole debate centers around the fact that antibodies react with more than one integer and antigens react with more than on anybody and when you have one or more things reacting with the same thing you can’t identify it so I thought I’d illustrate this problem there’s an important problem with some simple kitchen chemistry and we can imagine that we’re doing an antibody test but instead of using an HIV test kit with its proteins we’re going to use some milk which contains proteins and we’re going to put some proteins in this serving dish and we’re going to add two different things which react with the proteins in this milk so I’m going to take this lemon I’m going to squeeze some of the lemon juice into the milk I’m going to shake it around and you can see it’s getting thicker all the time that these lemon juice has reacted with the proteins in this milk reproduce to precipitate them this is how we know there’s been a reaction because there’s a physical alteration in the reaction mixture now I’ll do the same thing with vinegar okay entirely different substance from the former and I had some vinegar – another specimen look in a wait a little while and we say identical appearance because I’m going to put some lemon juice and some vinegar and other of these cups I’m going to do it out of view of the camera and I’m gonna do a third experiment I know what’s in these but you don’t now I’m going to add one of these unsurprisingly we also have a precipitate now which one did I add you can’t tell me can you know so when you have 280 buddies that react with the same antigen you can’t identify which anybody it is here I’ve only got 2 different substances in serum there’s hundreds of different antibodies each with the potential to react with an antigen the same antigen so when they say that they recognize that there is the ability for cross reactions in HIV tests they must have a way of identifying what is a cross reaction what is it the problem is this anybody’s can react with many different antigens and an antigen correct with many different antibodies once you get that into the equation you can’t – you can’t identify one from the other so you have to set it that’s that’s that’s that’s the guts of the problem that’s the essence of the problem you’ve no grounds for saying that anybody is HIV positive it’s just a contradiction in terms you you cannot say that these antibodies that are looked for with the H so-called HIV tests represent the presence of a specific virus that has never been proved that is possible definitely are you saying that there there is no gold standard and that’s why the tests are so flawed there is a gold standard the golf standard is HIV as proven by HIV isolation but when you search the scientific literature they’re not there no data published on this there’s no data where they compare the presence or absence of the antibody tests presence or absence of reactivity with the presence or absence of the viruses as proven by isolating it here you do not see anything about details but I would say it’s probably a virus these are HIV again yeah oh this is easy Javy – yeah yeah everything Wapiti probably yeah what can I tell you you know wait wait I mean it it exists yeah well said he had all these viruses and wasn’t why I think HIV totally has turned out not to be the cause of AIDS HIV has turned out not to be can you explain the process of HIV isolation well I didn’t dr. Gallo do that I mean he actually isolated it so I mean why should I do all of this this is all textbook stuff you’re asking me I’m not quite sure what’s behind your question about isolation I don’t want to be your textbook you know I got other

things to do today we have not yet proof for the existence of any of the HIV proteins and if you don’t have proof for the existence of other proteins you cannot have proof for the of the virus is it your belief with the current tests that we have today the fourth-generation tests that they say are so specific and so accurate that it’s completely impossible to determine whether that’s cross reaction or an actual positive what you know in fact that have third or fourth sorry second third fourth generation tests is modifying the antigens or the actual methodology and the test kits what counts is whether the antibodies truly are as a result of infection with the retrovirus HIV in the only way that you can prove that is to use HIV itself as a gold standard that’s true of any test so I could give you the example of the pregnancy test well you know if you as a previous a blood test for pregnancy which is pretty good but it has to be proven to be good before you can say it’s pretty good and the way you do that is that you test a whole lot of women with the test and you score the results positive or negative and then you see how many of them have a baby you don’t have a baby and you can cross correlate them using the baby is evidence of pregnancy it’s totally independent of the test okay there’s and when you do that you find that pregnancy tests in fact highly accurate they’re not perfect but they are pretty accurate in this case we can think of HIV is the baby okay and we’ve got an antibody testing you’ve got HIV and we want to see if the test is specific and to do that we would expect when we actually test for the do the antibody test we only ever find a positive test and someone who’s infected with the virus we wouldn’t we would ever expect to say someone who’s not infected with the virus with a positive test and that’s the only way we can put the numbers into the equations just by having those two sets of data so we’ve got the test that’s no problem we define what a positive test is whether it’s one band two bands ten bands one eliezer one western blot whatever whatever our test algorithm is and then we compare it with what we’re looking for so I think the intensity of question is we we don’t we don’t know we don’t know next one cat in 1994 Audrey Serrano tested HIV positive while initially healthy she was prescribed AIDS drugs which nearly killed her and left her scarred for life in December 2007 after multiple negative tests she was awarded 2.5 million dollars in damages people claim these tastes the 90 point 99.99% specific so we need to really understand what a specific me and I were thrown about used and specific means that the thing that you’re talking about has only one course an analogy that I sometimes use is if you see a vehicle driving down the street and all you see that is a little bit of the bonnet and a three-pointed star you know instantly what that vehicle is it’s so well known I don’t even have to tell you what it is correct but if you see if you’re walking along the road and you see it tire and you can’t say what vehicle that came from because all vehicles have tires so the three pointed star is specific highly specific for a particular thing in this case a Mercedes Benz whereas the tire is not so in our view because anybody’s cross-react because non HIV antibodies can react with the HIV proteins and they show the experts themselves don’t displease that’s the reason for example at 40 percent of people have a1 at least one wished and what better when you when you have this situation you have to assume that all the anybody reactions are nonspecific and then prove that they’re not and you do that by using a goal state that is what you what you say your test is testing in this case HIV it’s 7:00 a.m. here in Johannesburg South Africa and I’m a little nervous because I’m about to go in for my first HIV test my sex life well the your right to get an indication whether we have to expect a positive result or not no I I’m not gay and I’m not a hemophiliac I’ve never had a blood transfusion and I’ve never used

intravenous drugs so I don’t I think it’s impossible for me to have it what’s great about a rapid test well they’re less expensive and they’re very quick and we know that cheap and fast is always a sign of high quality these tests claim to be HIV tests I’m going to read from a section that’s code that says limitations of the test the specificity of the reveal rapid HIV antibody test for blood specimens in low-risk populations has not been evaluated they don’t know in their terms even how well this test is going to work in people they don’t want it to work in low-risk we don’t think you’re at risk rapid tests in Germany it’s not a lot for standard Diagnostics yes why how come you don’t use rapid tests for general Diagnostics several professional organizations who decide as an expert committee on guidelines how to do things none of these responsible societies recommend it for scientific reasons this is what this is the language all these tests use a reactive test result using the reveal HIV antibody test suggests that’s nice the presence of anti HIV antibodies that’s good okay we suggest that you’re going to die soon the reveal rapid HIV antibody test is intended to be used as an aid and aid in the diagnosis of infection with HIV but it’s the test I thought it was an HIV test no it’s just an it’s it’s a helper how does it help here’s how it helps results of the Med Mirror reveal test should not be used in isolation but in conjunction in conjunction with the clinical status history and risk factors of the individual being tested how do you decide how to interpret as a technician what do you do I will ask in addition is there pregnancy is there any allergy known is the additional information to make to have more information on if it could be cross reacting antibodies or to infect the problem is that we can’t distinguish between a false positive and a true positive HIV test the tendency is to call it a true positive if somebody is in one of the risk groups and for sure the first question is is there risk that I didn’t even talk about but it’s one of the very first questions it’s their risk for infection okay and is that the risk assessment section yeah if you have risk factors like you admit to being gay and to having had sex recently without a condom you’re suddenly at high risk and this test is very meaningful for you say we you come in you’re a straight guy come from a good family you’re a little worried because you had here a European fling but she was a nice girl now I don’t worry about it so did the answers to these questions help aid in the diagnosis really this is from a journal called AIDS alert – about their rapid test if the same test was performed on a thousand white affluent suburban housewives the low prevalence population in all likelihood all positive results will be false if the same test was performed in a thousand white affluent suburban housewives all positive results will be full they’ll be positive but they’ll be false why because we say so that’s why we say who’s positive we interpret in our way the last bit I said we interpreted our way if the same let me read you the whole quote whether the test will perform as well in the United States as they have abroad is still unknown experts at well why might tests work well abroad because we assume everybody who test positive we’re just gonna say they’re positive here it’s different for one thing using a single rapid test you know low prevalence population will give a lower positive predictive value that error rate won’t matter much in areas with a high prevalence of HIV because in all probability the people testing false positive positive will have the disease they’ll be testing false positive but they’ll have the disease we’re assumed we know they have the disease anyway and the test result doesn’t met that’s what that means in English welcome to AIDS doublespeak but if the same test was performed on a thousand white affluent suburban housewives a low prevalence population in all likelihood all positive results will be false and the positive predictive value plummets to zero that’s from AIDS alert magazine coming to your clinic candidate for rapid test what that means is they look at a group and they say there are this many people with AIDS in this area and you know we define a it’s clinically again we say that you have AIDS because we say that

you fit the criteria you know and when we say that you fit the criteria we say that the tests work better I know that rapid tests are used in African countries if you have a high prevalence of HIV infections you have less risk to to pick up false positives okay which might happen in countries like Germany with prevalence below 1% that makes a big difference in screening for HIV so in a low prevalence yeah yes you know because you pick up more easily you at the Falls reactives in the first essay in the screening assay okay the way that they pitch these tests is they they try to get them to be most reactive with the people who they think are more likely to be infected there’s an a priori assumption going on I’m gonna look at the black community and I’m gonna make tests and when I test them I’m going to make sure that I get the strongest reaction for whatever reason I don’t need to know with the blood that I draw from these various communities the knowing is beautiful campaign is one of the many Pro – you know go get tested its responsible campaigns put out by little political action communities like committees like amfAR and the idea is to tell everybody to go get tested but it’s not everybody they’re not interested in saying everybody but for example you don’t you don’t see the big ad at the bus stop in Beverly Hills knowing is beautiful be responsible you don’t see it in Chestnut Hill Massachusetts you don’t see it on the mainline in Philadelphia don’t see it in La Jolla California you don’t see it in Burbank you know I mean you see it we’re in the inner cities you go into downtown Philadelphia the whole thing is like you know aids land you go go into the Castro aids land you see so many ads for doing the responsible thing why because we believe for some reason that some people when they have sex will also die but some people won’t we forget that there’s a long history and humanity of actually reproduction you know there was that thing called the Crusades where people went all the way from Europe into Persia they had lots of sex with a lot of people they didn’t have a knowing this beautiful campaign yeah people probably didn’t have AIDS a lot of people probably died it any way you look at now we have this idea that these people these very specific people need to get tested so that they can be sort of monitored and we can help them I guess by by drugging them you know by offering them drugs that yes but we we know that once they get tested if they test reactive and we say that’s positive we know that they’re gonna die we know that you know so it’s really a great gift we’re giving if you see what I mean the test makers are very clear though that we don’t want to test in La Jolla we want to test maybe in downtown San Diego where a lot of the gangbangers live a lot of young Mexican kids live we want to test in uptown New York and 170 s where a lot of Dominicans live certainly not in the 70s where you know we’re the nice you know newspaper publishers and all these sorts of cable magnets lift you know the one that says are you positive you’re not positive you know whose picture is on that a black girls and a black guys I mean I I have him right here are you positive you’re not positive right there I’ll give you the picture another time but are you positive you’re not positive and here’s one that says the new face of HIV but it doesn’t say that it says that in the way about cata the V ash it says it in Spanish and there’s a picture of a young Latino girl the knowing is beautiful campaign is an idea that somehow using tests that don’t register anything specific is a meaningful thing to do to stop the problem of what we consider to be a sexually transmitted disease that’s clearly a toxicological multifactorial problem but we’re very clear about who we want to have tested and the medical literature is even more clear about it I think I would like to ask the question you really believe that after these many millennia of life on earth you know in 1983 or for a virus came out you know like a new product that would be sexually transmitted but only among the like Latin and and maybe black people and gay people gay men have

been targeted for testing in other words of the general population of the United States there has never been the mass pressure get tested take an HIV test but gay men the propaganda there is everywhere and so of course the more people you have taking the test the more positives you will get and to me this is a very sinister development or very sinister phenomenon they the gay viii establishment and the medical community that serviced the AIDS the gay AIDS community marketed the HIV test as the critical sign of whether you cared about yourself whether you wanted to live or not and it was very hard for anyone who was concerned about their health particularly anyone who had lived any any form of this lifestyle that that was being called into question to resist taking this test you had doctors who refused to treat patients who didn’t take the test you had doctors who refused to treat people who had taken the test who refused to take the AZT that was avail they would drop the patient this is what the Denver principles was about because there’s nothing worse than having you know your medical provider is supposed to be someone that you trust and that you think is going to help you and when they suddenly abandon you because you haven’t followed their direction it changes the relationship between the patient and the doctor because that’s supposed to be a partnership the doctor is supposed to give you his advice or her advice and you’re supposed to make a decision based upon that and if you say no that medical provider is supposed to respect your position that changed for the aides because you were not being a good patient if you didn’t do the HIV test if you didn’t do the drugs of the drug at the moment that was being told if you didn’t do those things then you wanted to die you know you want that’s a you know person who’s afraid of dying you know is terrified of dying a young person these were talking about all us all young people who’s terrified of done to be told if you don’t do this you’re gonna die and I don’t want to have anything to do with you that happened over and over and over again and that’s why when the PWA he’s got nationally got together for the first time in Denver I think was 1986 and drew up the Denver principles one of the first things than those principles was we have a right to say no to our medical provider and to be respected and to be continued to have a relationship with that medical provider

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