New CDC HIV testing recommendations could compromise patients' civil rights

CDC's revised recommendations on HIV testing in the U.S. -- that say HIV tests should become a routine part of medical care for residents ages 13 to 64 and that requirements for written consent and pretest counseling should be dropped -- could harm the health and civil rights of people who receive the tests, the American Civil Liberties Union said in a release on Thursday, CQ HealthBeat reports (Reichard, CQ HealthBeat, 9/22).

The recommendations, published in the Sept. 22 edition of CDC's Morbidity and Mortality Weekly Report, say health care providers should continue routine HIV testing unless they establish that less than one of every 1,000 patients tested is HIV-positive, "at which point such screening is no longer warranted." Providers do not have to require patients to sign written consent forms or undergo counseling before receiving an HIV test, but physicians must allow patients to opt out of the test, according to the guidelines. The recommendations -- which states can choose to adopt and modify -- also say that all pregnant women should be tested for the virus unless they opt out and that women who inject illicit drugs, are commercial sex workers or who live in a higher prevalence region should be tested again in the third trimester of pregnancy (Kaiser Daily HIV/AIDS Report, 9/22). "CDC should be commended for trying to increase the number of people tested for HIV, but eliminating the only safeguards that guarantee that testing is voluntary and informed does little to ensure that people will receive the care they need," Rose Saxe, a staff attorney with the ACLU AIDS Project, said, adding, "Without pre- and post-test counseling requirements, we risk losing a critical opportunity to educate people about HIV and how to prevent the spread of it" (ACLU release, 9/21). Saxe said privacy could be compromised under the guidelines because most states collect the names of HIV-positive people and "[m]any states also require doctors to report private information, such as drug use and sexual history about those who test positive." Kevin Fenton, director of CDC's National Center for HIV, STD and TB Prevention, said the recommendations will make "routine HIV screening feasible in busy medical settings where it previously was impractical," adding, "Making the HIV test a normal part of care for all Americans is also an important step toward removing the stigma still associated with testing" (CQ HealthBeat, 9/22).

Related Editorial

CDC "took the right step" in revising its HIV testing guidelines to recommend routine testing, which offers "the best hope to reduce the stubborn persistence of HIV infections in the American population," a New York Times editorial says. "[T]imes have changed" since the "early days of the AIDS epidemic," the editorial says, adding that new treatments have made early HIV diagnoses more "valuable," that the stigma surrounding the disease seems to have lessened and that health officials have proven they can keep test results private. In addition, written consent requirements "for HIV testing beyond the general consent forms signed by patients all too often scares patients away from a test that would help them," the editorial says. Analogous policies to CDC's revised recommendations for routinely testing pregnant women for HIV have "greatly reduced" HIV prevalence among infants, the editorial says, adding, "Surely it would be better for every [HIV-positive] individual to learn of his status as early as possible ... [a]nd surely it would be better for community health if hidden chains of transmission could be detected and interrupted to slow the spread of infection" (New York Times, 9/25).