Washington Blade - June 23, 2006
Lou Chibbaro Jr.

Aimed at drawing attention to the importance of HIV testing, Oldham's symbolic gesture on Wall Street comes at a time when the federal government is proposing that virtually all of the nation's health care providers - including private doctors and hospital emergency rooms - "routinely" administer HIV tests.

Recommendations issued March 7 by the U.S. Centers for Disease Control & Prevention call for health care providers to administer an HIV test to most if not all patients or clients that walk through their doors, even if the patient comes in for a sprained ankle or an upset stomach.

"We think this makes a lot of sense," said Leo Rennie, chief of HIV prevention surveillance at the D.C. Administration for HIV Policy & Programs. "We are really embracing the recommendation to make HIV testing routine."

Rennie noted that D.C. has the nation's highest per capita rate of HIV infection, and any changes that result in more people being tested can only help the city's efforts to combat the health crisis.

But representatives of local and national AIDS organizations have expressed concern over parts of the CDC recommendations that call for relaxing longstanding practices of providing counseling and written consent forms for those taking an HIV test.

Partially because bustling clinics and emergency rooms leave doctors and nurses little time for extra work, the CDC recommendations call for eliminating the traditional pre- and post-HIV test counseling that became an important part of HIV testing beginning in the 1980s.

The new recommendations also call for doing away with requiring the patient to sign a written consent form before taking the test and instead call for verbal "general consent" to overall medical care.

After being told an HIV test is to be given, the health care provider should assume that the patient has given his or her consent unless the patient declines by "opting out" of the test, according to the CDC recommendations.

Pluses and minuses

Leaders of the nation's AIDS advocacy groups and state and local health departments have mixed views on the new recommendations, with some embracing them and others calling for modifications.

"We encourage routine HIV testing," said Tom Kujawski, development director for the National Association of People With AIDS, which created National HIV Testing Day in 1995. "But we feel all should have access to counseling and referral to medical care."

Rebecca Haag, executive director of AIDS Action, a Washington, D.C. based national AIDS advocacy group, said her group also favors routine HIV testing, but with some limitations.

"Clearly, the key is to get to the high risk populations," Haag said. "The problem with routine testing is that many of the people in high risk groups are not in routine health care. Testing farmers in Nebraska may not get to the high risk groups."

Haag and Kujawski said their respective groups strongly support the CDC's goal of using more aggressive HIV testing to identify the large number of people who are HIV positive but don't know it.

The CDC has cited studies showing that a large percentage of those who don't know their positive HIV status are ethnic minorities such as African Americans and Latinos, many of whom don't learn they have HIV until they become ill.

At that point, CDC officials say, the risk for early death from AIDS-related illnesses rises dramatically compared to those who learn their status early and obtain treatment with drugs proven to be highly effective in blocking the disease from progressing.

AIDS advocacy groups have said African-American gay men, gay teenagers, and a category of people referred to as men who have sex with men - who often don't identify as gay - also fall into the category of individuals who don't know their positive HIV status.

Knowing status helps promote safer sex

The CDC says routine HIV testing would help identify people falling into these categories and would ensure that they obtain early treatment. CDC officials, with the backing of the Bush administration, have argued that more HIV testing also serves as an important means of preventing the spread of HIV.

"Most HIV-infected persons substantially reduce sexual behaviors that might transmit HIV after they become aware they are infected," the CDC says in its 22-page March 3 document, "Revised Recommendations for HIV Testing of Adults, Adolescents & Pregnant Women in Health Care Settings."

"Many persons, including many with HIV infection, do not perceive their HIV risks or do not disclose them," the document says. "Further, performing testing routinely reduces the stigma associated with testing that requires ascertainment of behavior risks. More patients accept recommended HIV testing when it is offered routinely to everyone, without a risk assessment."

In San Francisco, among the first cities to be hit hard from the AIDS epidemic, some health officials are proposing a relaxation in longstanding rules that require a written consent form. The San Francisco AIDS Foundation objects, saying written consent should remain a part of all HIV testing.

The head of New York City's Department of Health & Mental Hygiene, Dr. Thomas Frieden, has proposed changing a New York law to allow HIV tests with only "documented oral consent" instead of written consent.

The Gay Men's Health Crisis, a New York City AIDS advocacy group, has raised objections to eliminating written consent forms associated with HIV testing.

While supporting Fieden's and the CDC's call for making HIV testing a routine part of medical care, GMHC says informed consent should remain an important part of all HIV testing.

"We are convinced that written consent should continue to be required to ensure that HIV testing remains voluntary in practice and not just in theory," the group said in an April 4 statement.

Patients should not be made to "simply acquiesce to being tested" and should not be "made to feel coerced," the statement says.

Rennie, of the D.C. AIDS administration, said city health officials plan to develop ways to streamline the counseling process.

The Whitman-Walker Clinic, the city's largest private health care provider for people with HIV, is working with at least two D.C. hospitals to provide HIV services to people who test positive through soon-to-be-started routine HIV testing at the hospital's emergency departments, according to Philippe Chiliade, the Clinic's medical director.

"We will adopt the CDC recommendation at our STD clinic," Chiliade said.

Other groups, such as the AIDS Institute, which lobbies Congress on AIDS-related policies, have said the federal government must provide adequate funding for expanding HIV testing and the health care needed to treat the increased number of people found to be HIV positive.

"The funding is already inadequate," said Carl Schmid, the AIDS Institute's federal affairs director.

060623
WB060614

Always watch for outdated information. This article first appeared in 2006. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2006. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .