Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
Chicago Tribune - June 3, 2006
Patients would have the option of declining the test with a simple "no thanks." But those who agree to be tested would not have to sign a separate consent form attesting that the blood test and all its ramifications have been explained to them--as is required by Illinois law.
The CDC apparently believes that pesky informed-consent process is an obstacle to testing, and thus to reducing the spread of HIV.
Wider testing to control HIV seems like a good idea. People need to know they have the virus in order to get treatment and avoid infecting others. Making HIV testing a part of routine health care can help to reduce the stigma attached to a diagnosis. But it's unclear if removing the pretest counseling and written consent would have the desired effect.
CDC officials point proudly to the reduction of HIV infection in newborns due to routine testing and treatment of pregnant women. Illinois' program of counseling pregnant women and urging them to be tested has been particularly successful. Nearly every woman who is told how she can protect her baby from HIV agrees to be tested, either during her prenatal care or when she arrives at the hospital to deliver.
But that testing is voluntary. And in Illinois, which has been particularly successful, it is part of a comprehensive counseling program. (A bill passed by the legislature this year will make HIV testing mandatory for newborns whose mothers' HIV status is unknown. It remains to be seen whether that will reduce the already low number of babies infected at birth.)
Advocates for patients fear testing won't be truly voluntary without pretest counseling. Their bigger concern is that, without counseling, people at risk for HIV won't get the information they need to avoid risky behavior and to find care if they are infected.
There's no scientific evidence that universal HIV testing is beneficial, which could mean insurers may not pay for the test. The CDC's plan could turn out to be harmful if it ends up undermining current prevention efforts. Illinois law in the area of HIV testing is sensible. It is sensitive to the needs of people who might find out they're positive for the virus and it helps get those people into treatment. The wishful thinking of the CDC is no reason to change it.
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