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Doug,

Even with your stipulation, the risk is still there. If you and your wife had testing BEFORE your marriage, then yes, the odds are on the side of the shark scenario. But most couples today are not tested. And to tell them that they are safe just because they are loyal to one another is not your place.

So, unless you and the Mrs. were both virgins at the time of your marriage, (NO I don't want any details) then the chance is there. Yes, even after all these years.

You must be afraid of a simple blood test to take so much of your time to convince people NOT to test.

The point is, it's a simple test. IT's available for anyone that wants it. Why not? Sad as it sounds, it has happened that someone believes they're in this perfect monogomous relationship then BAM, someone gets HIV. Not all relationships are as perfect as yours with the Mrs.

I understood your article the first time around and I saw where you were coming from. But now that I see you so adamently deny that it could happen, I must remind you that the only way we can know FOR SURE, is to take the simple test.

Thanks for the comment.

The "Mrs." and I go back 30 years -- before AIDS popped up in this country.

Also, I'm talking about relationships that are built on love and trust.

You trust your partner to love you enough to tell you if there's any reason you both should be tested.

Some of those relationships still exist.

Furthermore, this universal testing advisory applies even to people who are not sexually active at all and never have been. How does that make sense?

Doug, I agree with you on this entirely. We agree because we are thinking about this on the basis of individuals at risk.

The CDC, however, is thinking about populations as much as (or more than)it is thinking about individuals. That is what public health does. It is concerned with transmission of the virus in populations, and probably concludes that one of the most practical, complete ways to contain this is to get everyone tested. The question is whether everyone needs to follow this directive in order to facilitate the CDC's objectives among large populations. Your position makes sense.

Thanks, Joe. As a medical guy, your view carries a lot of credibility.

I do understand that from a public health standpoint, of course the best approach is to cast the widest net possible. But you have to accept that for 99+ percent the effort will turn out to have been unnecessary.

You are precisely right, which is why screening programs are sometimes targeted to at-risk groups. By doing this, you increase the predictive value of the test. But the CDC decided not to take this approach, which means we will be paying for a lot of negatives (and perhaps a number of false positives also.)

We don't have polio anymore in the US, not really, but we still give kids polio vaccines (at least they did with my kids). We're not talking only about risky behavior or trust between husband and wife (this from a 34-year married person). We're talking about health and public policy.

If all people are tested, there's no stigma about being tested. If you and I are tested, even though we have no real or perceived risk, then it's OK to test everyone with nothing implied about their behavior. It's good for all people.

I can't imagine a doctor actually ASKING if you want a medical test that could find a disease that could kill you and for which there is no known cure yet. Why would a doctor even ask?

AIDs testing should be done for everyone, including newborns, because it catches the off-chance, the anomaly, the blood recipient, the 10-year-old relationship, the whatever. I cannot imagine my pediatrician asking if I wanted to give my kids polio vaccinations. Why is this different?

The problem arises, not with the CDC. they are certainly looking at the benefits of testing populations, and the positive benefits therof. the problem will be with health insurance providers. I can envision a scenario where, due to mass HIV testing, those who test positive are excluded from insurance benefits, or at the least wind up paying much higher premiums than before. In this day there is no such thing as a confidential medical record. The Medical Information Bureau does an excellent job at disseminating confidential medical history to any Insurer that requests it. In light of the recent "accidental" releases of credit histories, not to mention identity thefts, I would expect to see similar releases of HIV history. Do we really want all of our health information stored in a data bank somewhere, just waiting for a hacker to steal it?

Sue, HIV and polio are different in their modes of transmission. A child can be exposed to the polio vaccine almost randomly. Fortunately, the chances of exposure in this country are very remote, but polio remains a real threat in other parts of the world, such as Africa. If there were an HIV vaccination, I would agree that general administration would make sense.

Many, many people in this country have not been vaccinated for polio. I didn't get mine until this past summer and I'm 23 years old.

Kenny,

Shame on your parents!

"Sue, HIV and polio are different in their modes of transmission."

Yup. You can get polio from airborne bad things. And you can get AIDs from a blood transfusion.

Oh wait. You mean that sex thing. Sure, we should never test for sexually-transmitted diseases, like those pesky marriage blood tests that were required almost nationally for a bunch of year. Right?

Are you recommending those marriage blood tests for long-married couples now, Sue? Have you had yourself tested for HIV? If not, then just what are you arguing for Here?

Kenny had whatever vaccinations were recommended/required.

It's great when someone gives you a point you can argue and you can ignore something that makes a lot of sense - Sue's very good point was that when everyone is tested, then there will be no stigma to the test, and no one has to worry about what it says about you that you want one. You, for example, seem EXTREMELY worried that someone will question your behavior if you get an HIV test.

I've been meaning to respond to your column because (this may just be envy talking) you live in a fantasy world. I'm very glad that you have never been betrayed, nor have ever met anyone who has been betrayed, nor have even been near a total stranger suddenly blindsided by the news that their partner has "moved on," but the fact is individuals can only control their OWN risk factors, NOT their partner's. My own marriage is a partnership based on absolute trust and confidence, but I still would get tested if it weren't for the stigma. I trust my husband with my life - but that doesn't mean that I should abdicate my responsibility to myself.

Your reasoning is exactly the same as a parent who doesn't believe that their child needs sex ed or AIDS info. Many parents "know" that their children are not sexually active and therefore don't need tests, vaccines or information. What a horribly shortsighted view!

Finally, it made me sad to read your "you trust your partner to love you enough to tell you if you need to get tested" comment. I think that your attitude has made this a lot less likely for you. It IS a simple test, too bad it's not part of a routine physical so you wouldn't have to worry about it so much.

Melissa, thanks for your comment.

When you talk about stigma, you're making a social argument, not a medical argument. There might be a stigma for someone about going to a soup kitchen if he's hungry, but that doesn't mean all of us should eat at soup kitchens for the sake of removing the stigma for some.

I'm puzzled by your statement that you trust your husband with your life but you owe it to yourself to get tested. That strikes me as a direct contradiction. Sounds like Ronald Reagan's stance toward negotiating nuclear arms agreements with the Soviet Union: Trust, but verify. Of course, Reagan never really trusted the Russians.

Doug, you really appear to be willfully missing the point yourself, now.

Since your original column was about the CDC recommendation, I recommend that you check out the CDC, its mission, objectives, and strategies: http://www.cdc.gov/about/default.htm. I am quite fascinated by your worldview that can envision public health without any social considerations. The CDC sure doesn't.

Why are you so uncomfortable with trust but verify? Do you apply blind faith to all aspects of your life? Are the most important things in life - your health, life, marriage - the right place to apply blind faith?

If you think so, let's just agree to differ, and I hope that you are able to live the entire of a long, prosperous life without ever knowing betrayal.

Thanks again, Melissa. CLearly we will continue to disagree.

Joe Guarino addresses the public health aspect in his comments.

No, I don't endorse blind faith at all. My trust in my wife, for example, already has been verified again and again 30 years of experience. In this matter, should I conclude that it all really means nothing? I can't imagine a life without faith and trust in anything. For me, it would be very empty and sad.