The diagnostic usefulness of cerebrospinal fluid lactic acid levels in central nervous system infections.

of communication during clinical care; diversification of the clinical staff; optimization of the receipt of care and HAART; and enhancement of adherence to treatment. All of the preceding strategies are good ways to reduce the negative impact of HIV infection and AIDS on minorities and to " improve the likelihood that minority patients will engage in care, be satisfied with care, and have positive HIV/ AIDS-related outcomes " [1, p. 403]. Stone did not mention another potentially culturally sensitive mechanism for improving the care of minorities with HIV infection and AIDS, which is utilization of routine testing for HIV instead of risk-based testing. Routine testing for HIV in the primary care setting should help to decrease the social stigma associated with screening for HIV and AIDS by the equitable offering of the test to all sexually active patients. This form of testing still requires the patient's consent but does not require the health care provider to conduct an intrusive inquiry into the patient's social or sexual history prior to testing. Often , patients, health care providers, or both feel uncomfortable when probing or being probed for sexual and social histories [2, 3]. A recent study demonstrated that patients from underserved minority populations and from the majority population have indicated their willingness to undergo routine testing [4]. Several studies have found that those at risk from heterosexual contact underestimate their risk for HIV-infection and frequently present to a clinic later in the course of the infection [5, 6]. Routine testing has helped to identify HIV infections earlier in the course of the infection, has helped to identify those who are unaware of their HIV infection status [7, 8], and may increase overall awareness of people in both the heterosexual and the same-sex risk communities who underestimate their risk for the disease. Routine testing has been shown to be acceptable to prenatal patients and their health care providers. More importantly, this form of testing may reduce the stigma currently associated with HIV testing, which contributes to the late diagnosis of HIV infection. In one study, 140% of patients received a diagnosis of AIDS within 1 year after diagnosis of HIV infection [9]. HIV/AIDS is not the same disease that it was at the beginning of the epidemic. The epidemiology of this disease has changed; the disease is now a chronic instead of a fatal illness. The medical profession needs to respond appropriately …