Students: STD testing discouraged

by Allison Caffrey | 11/22/02 6:00am

Although Dick's House offers all enrolled Dartmouth students testing for sexually-transmitted diseases and HIV, many who have requested to be tested this year allege that administrators at the health-care facility have encouraged them not to undergo some tests.

Several students, who wished to remain anonymous for privacy reasons, told The Dartmouth that when they asked to be tested, the staff at Dick's House tried to talk them out of it. Staff members, they said, cited concerns that Dartmouth students get tested too often and suggested that it was a waste of money for Dick's House to be administering so many tests.

"When the nurse told me that Dartmouth students got tested too much, I was outraged," one student said. "Isn't it better to be safe than sorry?"

"In light of the recent report on the increase of genital herpes on campus, I would think that students would be encouraged to get tested," another said.

The biggest problem, according to Director of Women's Health Elizabeth Hirsh, is a lack of standardization in the area of STD testing. She said that confusion often arises when students come in and ask to be tested for STDs in general.

Since no single test can detect all STDs, the determination of which tests to administer is made on a case-by-case basis. With no standard list of tests, there is a good chance that a student's definition of "general testing" and a health care provider's definition will not be exactly the same.

One student who asked for "general testing" reported being tested for chlamydia, gonorrhea and syphilis. Another student who asked for the same thing received tests for hepatitis B and C in addition to gonorrhea, syphilis and chlamydia.

Dick's House looks to the Center for Disease Control for guidance on what tests it should administer. However, even the CDC does not have a consensus on a standard list of tests. Therefore, the staff at Dick's House takes multiple factors into consideration when deciding what to test patients for, according to Hirsh.

The doctors and nurses consider a patient's risk factors, including how many sexual partners he or she has had and how many partners their partners have had. They also look at statistics from Dartmouth-Hitchcock Medical Center and Dick's House and take into consideration which STDs are prevalent in Hanover and on the Dartmouth campus when making recommendations to student patients.

After considering all of the factors, the staff makes a recommendation to the patient on which tests they should take. Hirsh said that there is "no desire to cut corners," especially for budget reasons.

"We would never turn away a student who wanted to be tested. While we assess risk factors and make recommendations, we are sensitive to the fact that the patient might not be telling us everything," she said.

All STD testing is built into Dick's House's budget. Each year Dick's House negotiates and pays a lump sum to the DHMC laboratory, and that sum covers all STD testing for the entire year. DHMC has not yet released that number to Dick's House for this year.

Based on this system, there is a long, comprehensive list of tests that are covered by Dartmouth student medical insurance. This test covers everything from Hepatitis A, B and C to herpes and HIV. However, there are two types of tests for herpes, and the one currently recommended by the CDC is not covered. This means that while students can still receive this test, it comes at an extra charge of about $48.

While this extra charge might be covered by a student's secondary insurance, Hirsh warned that a student's confidentiality could be compromised. This is because the charge generates a bill that could end up with a student's parents or guardian.

However, receiving STD tests not covered by the College's insurance plan is the only time that a procedure at Dick's House is not completely confidential, according to Hirsh. Everything else is secure in a person's medical records and can only be released by the patient.

Many other colleges and universities have policies that are similar to Dartmouth's. Institutions such as Harvard, Duke, Brown, Stanford and Amherst all provide comprehensive and confidential STD and HIV testing as part of their student health care package.

"We like to see that students are active participants in their health, and hopefully they will continue to get tested when they think that they need to be," Hirsh said.