HIV and Hepatitis Testing Before Surgery Question

I was reading through my pre-surgical blood work requirements to have a face lift in Costa Rica, and I see that I need to get tested for HIV and Hepatitis C. I remember that when I had my implants put in 18 years ago, my U.S. surgeon required it, also.

When I asked my personal physician to do the testing back then, I was told that I should go to the Health Department to have it done because of potential problems with insurance (both health insurance and life insurance) should I come back positive. I don't really remember all of the details, but it seems like I had an issue with the health department giving me a slip with a number on it, rather than my name (to remain anonymous, I guess), and my surgeon was not happy about it, but went ahead and did surgery since I was already prepped.

I'm sure that things have changed with HIV testing over the last 18 years, but I was wondering if any of you were required to do these tests, and how you went about getting them done? Did you have your personal doc do them? Health Department? Have them done when you got out of country (my surgeon offers that option, I think)?

If you went to the health department, did you use a local one? I'm asking that because I live in a very small, rural area. It's going to be hard to walk into that office and ask for these tests without telling them about my cosmetic surgery (if I don't tell them, their imaginations will REALLY run wild wondering why a person who's been married 23 years needs an HIV test, lol). No HIPPA law is going to stop all the gossip in this small town. Maybe going to a larger town would be better.

Any suggestions would be greatly appreciated.

The testing is often done in order to protect the surgeons from risks of blood-born pathogen exposure during surgery.  They can take extra precautions.  Yes, health departments do blind HIV testing. 

Marriage does not prevent HIV.  Many spouses lie.  And there are other ways of contracting it such as dirty instruments at a dentist.  Doctors shouldn't have to trust their patients on such issues. 

Aren't they doing other tests as well?  It will just appear as a normal pre-op set of orders.  These tests are all very common now.  It should not raise any eyebrows. 

Thanks, Chris, and you make a valid point that married people get HIV and Hepatitis, too. Anyone who is sexually active or who has had as many surgeries as I have over the years could come back positive. Just one more reason NOT to get tested in my small town, lol.

I do have orders for all of my other blood work, but I guess I'll have to go back and have her add those two things to my orders before I get my blood drawn. It was my doctor (a different one than I use now) that advised me to get confidential testing all those years ago, but as you mentioned, it is much more common to be tested these days. 

Thanks for the reply.

The county I live in offered free HIV screening (a mouth swab rather than a blood test) and Dr. Lev accepted those results.  The Hep B I had done by a place I found on the Internet called Walk-In Labs.  My PCP ordered the rest.  Maybe go to the next county from yours and see what they offer? 

CIMA Hospital can also do the tests but you would have to arrive a few days before surgery so that the results would be available beforehand.

Thanks! I'd sure hate to get to Costa Rica and find out I had one of those two illnesses, lol. I'd probably just turn around and go home, and skip the surgery.

I guess I'll call my doctor that has been doing my pre-surgical screening (I was scheduled for a tt/bl on January 26th, so I've had everything except my blood work done) and see what she suggests.

I don't know if people still have to be concerned about losing health or life insurance these days if they were to come back positive or not. That's why I was wondering what other people did. I know that when I got life insurance years ago, they required their own HIV test before approving my insurance.

The company that my husband works for has started offering their employees a 100.00 gift certificate (for each insured person in the family) to willingly disclose their medical history to a nurse that works for the company. I can't imagine that anyone would actually fall for that, but it's interesting to me that while a company can't access that information legally, they can offer a person money to get them to disclose their medical history. 

Health departments offer free HIV testing, and you get a number to protect anonymity (sp?).  Everything is confidential.

Thanks. Is that what you had to do? I did that last time (18 years ago), and my doctor had a fit and almost cancelled my surgery because the paperwork I brought him had a number instead of having my name on it.

I do not require the tests, but if a person has been ill from either HIV or Hep C then I need to be aware of where they are in terms of treatment.

Most surgeons and hospitals now practice "universal precautions" which simply means that we treat every patient as though they have a transmissible disease.  Hence I do not do routine screening.

As for testing ":just to see" if you test positive, I would be very cautious about that. If you have known risk factors or exposure, then I support getting tested.  If not, I am very wary of patients becoming "uninsurable" in the future. 

I have no confidence whatsoever in test results remaining confidential when insurance companies have so much to gain by denying coverage to at-risk individuals.

If your doctor will accept an anonymous test result, then fine.  As for my staff and I, we are going to be careful no matter what and if there is an accidental exposure,  we will do the needed tests later after speaking with the patient.

Thank you SO much, Dr. Lomonaco, for taking the time to reply. You perfectly addressed my concerns. We are insured with Blue Cross, and I have noticed a trend over the last few years of Blue Cross trying to find out information about the health of their customers from customers themselves. The only reason I can see that they would go to such lengths would be that they can't legally get all of that information on their own.  

Maybe it's just good business on their part and I'm being paranoid, but I think they have more than enough information about my health without my calling them and giving them more. They send me post cards telling me that I can call their "nurse line" before seeing a doctor if I need guidance on what is or is not an emergency. They offer nutrition programs, programs to help people stop smoking, and things like that.  I figured out a long time ago that their main interest, as is true with most any business, is to make money. They don't actually care about me as an individual, and I'm not comfortable giving them information that may make me uninsurable or cause claims to be denied. The same holds true for life insurance. 

Even going to a health department is a risk since if I go to one out of my area and were to come up positive, my understanding is that the findings will be reported to my local health department anyway. 

This is an interesting topic. As you point out, any person who is trained work with infectious disease would be wise to assume that every patient is positive to bloodborne pathogens. Still, I don't blame a surgeon for wanting to know in advance, just in case an exposure incident occurs. 

I hope you come back to read this reply, because I want to ask if you know of Dr. Lev? I'd love to hear you say that he's a great doc (or at least one that you have heard of)! Of course, YOU would be my choice surgeon if I could only afford your services. I've seen the work that you've done on many people on this site, and you are a true artist. Thank you for all that you have done (and continue to do) for so many. I want to come work for you once I finish my nursing clinicals! I know that at 51 I'm starting my career at retirement age, but if Dr. Lev does his job well, I'll look much younger than my years, lol.

Thank you again for your reply. I appreciate your time and your wise advice.

Hi. Good luck with your nursing clinicals !  Its hard work but the hands-on part is exciting for most. 

Did I read that you were going to CR for surgery ?  I have travelled there for many years and they have a great system, especially the new and modern CIMA hospital system. 

Well I can't say I know your doc, but I did look him up and read from his website.  His credentials seem very solid (Brazilian plastic surgery training) but I have criticism aabout some stuff on his coordinators website.  She needs to delete the part on her webpage about him being so busy and rarely able to answer emails AND that he performs the "unheard of " service of actually seeing patients postop and removing stitches.

To me, those are minimum standards not exceptions.  And since followup by email is going to be a huge part of any overseas surgery, I would be sure you have a care plan at home in case that's needed.

Best Wishes,

Dr L.