HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Friday, September 22, 2006

Routine HIV Testing

Yesterday, the Centers for Disease Control and Prevention recommended that HIV testing become a routine part of medical life for Americans from ages 13 to 64.  The CDC hopes that such testing will help prevent the spread of the disease and through early diagnosis increase the needed care for those who are unaware that they have the disease.  The AP reports,

"By identifying people earlier through a screening program, we'll allow them to access life-extending therapy, and also through prevention services, learn how to avoid transmitting HIV infection to others," said Dr. Timothy Mastro, acting director of the CDC's division of HIV/AIDS prevention.

Although some groups raised concerns, the announcement was mostly embraced by health policy experts, doctors and patient advocates. "I think it's an incredible advance. I think it's courageous on the part of the CDC," said A. David Paltiel, a health policy expert at the Yale University School of Medicine.  The recommendations aren't legally binding, but they influence what doctors do and what health insurance programs cover.

However, some doctors' groups predict the recommendations will be challenging to implement, requiring more money and time for testing, counseling and revising consent procedures. Some physicians also question whether there is enough evidence to expand testing beyond high-risk groups, said Dr. Larry Fields, the president of the American Academy of Family Physicians. "Are doctors going to do it? Probably not," Fields said.  But the recommendations were endorsed by the American Medical Association, which urged doctors to comply. . . . .

Under the new guidelines, patients would be tested for the AIDS virus as part of the standard tests they get when they go for urgent or emergency care, or even during a routine physical. The CDC recommends everyone get tested at least once, but annual testing is urged only for people at high risk.

Consent for the test would be covered in a clinic or hospital's standard care consent form. Patients would be allowed to decline the testing. The CDC's guidelines say no one should be tested without their knowledge.

An American Civil Liberties Union official protested the CDC's idea of dealing with HIV on standard consent forms, and the agency's de-emphasis of pre-test counseling. "By eliminating these safeguards, what they're calling 'routine testing' will in practice be mandatory testing," said Rose Saxe, a staff attorney with the ACLU AIDS Project.  Doctors should tell patients anonymous testing is also available, if they'd rather choose where they want to get HIV testing, Saxe said.

The cost of the new policy is not clear. A standard HIV test can cost between $2.50 and $8, public health experts say.

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