15 JULY
Correspondence Early HIV Detection: Responsibility of Physicians or Church? TO THE EDITOR—My interest was piqued by the recent article by Wagoner and colleagues [1] in Clinical Infectious Diseases. However, one did not need to be an astute reader to realize very quickly that the title of the article is not only provocative, as the authors suggest, but it is also deceptive and there are multiple questions that arise in terms of the quality of the science at the heart of the article. The study is based on self-reported behavior of new patients at the human immunodeficiency virus (HIV) clinic. Such studies have inherent drawbacks [2]. Readers are not privy to the detailed questionnaire. What exactly was the authors’ definition of church attendance? What exactly did the patients mean by their answers? Answering yes/no did not lend itself to differentiation between attendance once in a lifetime vs once a year vs once a month or once a week. What was the evidence for the reliability and validity of the questionnaire? We are also well aware that CD4 counts are low in the presence of acute infections. Were any of the patients unwell at the time of the presentation and were there follow-up CD4 counts to confirm the immune status in the absence of clinical symptoms? The most glaring bias from the authors is evident as one reads the Discussion section. While the finding that men who have sex with men who attended church had lower CD4 counts made the title of the article, the finding that women who attended church reported previous HIV testing more often than women who did not attend church was relegated to passing mention in the Results section. Shame on the authors for selectively highlighting part of their
316
•
CID 2014:59 (15 July)
•
findings, and shame on the editor for publishing such an article in this prestigious journal. I wonder what “level of evidence” would be assigned to this article. With looming cuts to federal funding, one wonders why the National Institutes of Health funded this study. In the political circles of Washington, one often hears the cliché “there is enough blame to go around.” In the case of this article, there is enough shame to go around! “Church” is often a soft target where folks lay blame for many social ills. Let’s look at ourselves—the medical community—and take responsibility in terms of early detection of HIV. Since 2006, the Centers for Disease Control and Prevention has guidelines encouraging HIV testing [3]. More recently, the US Preventive Services Task Force expanded these recommendations even further [4]. Church outreach may help, but we physicians need to do a better job in early detection of HIV. It would also be a disservice to patients with HIV, cancer, and other chronic conditions to berate the services of “church” when such services provide psychological and spiritual benefits beyond what medications can do [5]. Note Potential conflicts of interest. Author certifies no potential conflicts of interest. The author has submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Alwyn Rapose University of Massachusetts Medical School and Reliant Medical Group, Worcester
References 1. Van Wagoner N, Mugavero M, Westfall A, et al. Church attendance in men who have
CORRESPONDENCE
2.
3.
4.
5.
sex with men diagnosed with HIV is associated with later presentation for HIV care. Clin Infect Dis 2014; 58:295–9. Saczynski JS, McManus DD, Goldberg RJ. Commonly used data-collection approaches in clinical research. Am J Med 2013; 126: 946–50. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006; 55:1–17. Moyer VA; US Preventive Services Task Force. Screening for HIV: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013; 159:51–60. Holt-Lunstad J, Steffen PR, Sandberg J, Jensen B. Understanding the connection between spiritual well-being and physical health: an examination of ambulatory blood pressure, inflammation, blood lipids and fasting glucose. J Behav Med 2011; 34:477–88.
Correspondence: Alwyn Rapose, MD, University of Massachusetts and Reliant Medical Group, 123 Summer St, Ste 220, Worcester, MA 01608 (alwyn.rapose@reliantmedi calgroup.org). Clinical Infectious Diseases 2014;59(2):316 © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. [email protected]. DOI: 10.1093/cid/ciu262
Correspondence Early HIV Detection: Responsibility of Physicians or Church? TO THE EDITOR—My interest was piqued by the recent article by Wagoner and colleagues [1] in Clinical Infectious Diseases. However, one did not need to be an astute reader to realize very quickly that the title of the article is not only provocative, as the authors suggest, but it is also deceptive and there are multiple questions that arise in terms of the quality of the science at the heart of the article. The study is based on self-reported behavior of new patients at the human immunodeficiency virus (HIV) clinic. Such studies have inherent drawbacks [2]. Readers are not privy to the detailed questionnaire. What exactly was the authors’ definition of church attendance? What exactly did the patients mean by their answers? Answering yes/no did not lend itself to differentiation between attendance once in a lifetime vs once a year vs once a month or once a week. What was the evidence for the reliability and validity of the questionnaire? We are also well aware that CD4 counts are low in the presence of acute infections. Were any of the patients unwell at the time of the presentation and were there follow-up CD4 counts to confirm the immune status in the absence of clinical symptoms? The most glaring bias from the authors is evident as one reads the Discussion section. While the finding that men who have sex with men who attended church had lower CD4 counts made the title of the article, the finding that women who attended church reported previous HIV testing more often than women who did not attend church was relegated to passing mention in the Results section. Shame on the authors for selectively highlighting part of their
316
•
CID 2014:59 (15 July)
•
findings, and shame on the editor for publishing such an article in this prestigious journal. I wonder what “level of evidence” would be assigned to this article. With looming cuts to federal funding, one wonders why the National Institutes of Health funded this study. In the political circles of Washington, one often hears the cliché “there is enough blame to go around.” In the case of this article, there is enough shame to go around! “Church” is often a soft target where folks lay blame for many social ills. Let’s look at ourselves—the medical community—and take responsibility in terms of early detection of HIV. Since 2006, the Centers for Disease Control and Prevention has guidelines encouraging HIV testing [3]. More recently, the US Preventive Services Task Force expanded these recommendations even further [4]. Church outreach may help, but we physicians need to do a better job in early detection of HIV. It would also be a disservice to patients with HIV, cancer, and other chronic conditions to berate the services of “church” when such services provide psychological and spiritual benefits beyond what medications can do [5]. Note Potential conflicts of interest. Author certifies no potential conflicts of interest. The author has submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Alwyn Rapose University of Massachusetts Medical School and Reliant Medical Group, Worcester
References 1. Van Wagoner N, Mugavero M, Westfall A, et al. Church attendance in men who have
CORRESPONDENCE
2.
3.
4.
5.
sex with men diagnosed with HIV is associated with later presentation for HIV care. Clin Infect Dis 2014; 58:295–9. Saczynski JS, McManus DD, Goldberg RJ. Commonly used data-collection approaches in clinical research. Am J Med 2013; 126: 946–50. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006; 55:1–17. Moyer VA; US Preventive Services Task Force. Screening for HIV: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013; 159:51–60. Holt-Lunstad J, Steffen PR, Sandberg J, Jensen B. Understanding the connection between spiritual well-being and physical health: an examination of ambulatory blood pressure, inflammation, blood lipids and fasting glucose. J Behav Med 2011; 34:477–88.
Correspondence: Alwyn Rapose, MD, University of Massachusetts and Reliant Medical Group, 123 Summer St, Ste 220, Worcester, MA 01608 (alwyn.rapose@reliantmedi calgroup.org). Clinical Infectious Diseases 2014;59(2):316 © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. [email protected]. DOI: 10.1093/cid/ciu262
