Washington Blade - September 29, 2006
Lou Chibbaro Jr

The U.S. Centers for Disease Control & Prevention, which issued the recommendations on Sept. 21, said it remains committed to strict privacy protections for those who take an HIV test. But CDC officials said the rate of new HIV infections in the United States has remained at about 40,000 each year for more than 10 years, and a new and more effective policy was needed to break that cycle.

Those who learn they are HIV positive are far more likely to take steps to prevent spreading the virus to someone else, CDC officials said. And those who learn their HIV status as soon as possible after becoming infected are far more likely to obtain treatment from drugs that prevent them from developing full blown AIDS, officials said.

The recommendations call for health care providers to make voluntary HIV screening a routine part of medical care at least once for all patients between the ages of 13 and 64. An HIV test should be made available on an annual basis for persons deemed at high risk for HIV, the recommendations say.

The screening would take place in hospital emergency rooms, doctors' offices, and private and public medical clinics, with an HIV test recommended for people entering these health facilities for any reason, including a sprained ankle or the flu.

In their most controversial provision, the CDC recommendations call for doing away with pre-test counseling and written consent forms û elements of HIV testing that have been provided since the mid 1980s. Instead, the recommendations call for doctors or other health care workers to obtain verbal consent after providing a patient with a clear description of what an HIV test is and how it could have an impact on the patient's life if he or she tests positive.

"These new recommendations will make routine HIV screening feasible in busy medical settings where it previously was impractical," said Dr. Kevin Fenton, director of CDC's National Center for HIV, STD and TB Prevention.

CDC officials cited studies showing that bustling hospital emergency departments and busy clinics often choose not to provide HIV tests to patients because the requirements for pre-test counseling and signed, written consent forms take too long.

"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," Fenton said.

Fenton and other CDC officials cited other studies showing that including an HIV test as a routine part of the normal medical tests given during doctors' visits, such as blood pressure readings and blood tests for cholesterol, remove the stigma previously associated with HIV tests.

People who test positive should receive "prevention counseling" to ensure they take steps to avoid infecting others, the recommendations say. Those testing positive also should be assisted in obtaining ongoing care, including treatment needed to keep the virus in check, the recommendations say.

Concerns over counseling

AIDS Action, a national AIDS advocacy group, and the National Association of People With AIDS, expressed support for the CDC recommendations for routine AIDS testing. But officials with the two groups said they were concerned that health care facilities providing the testing might not be equipped to provide adequate counseling and follow-up medical care for those who test positive.

The AIDS Institute, a national group with offices in Florida and Washington, D.C., said it was pleased that the CDC made changes in an earlier draft version of the recommendations to ensure that patients are explicitly informed that they can "opt out" of an HIV test and that information about the test be offered in several languages in addition to English.

"The guidelines issued today that seek to make HIV testing routine in health care settings are long overdue," said Gene Capello, the institute's executive director.

Lambda Legal Defense & Education Fund, a national gay litigation group, said it supports the routine testing provision of the CDC recommendations but strongly opposes doing away with pre-test counseling and written consent forms.

"Pre-test counseling, including information about risk behaviors and risk reduction, is vital," said Bebe Anderson, Lambda's HIV Project director.

"Health care providers who follow these guidelines will miss an important opportunity to educate those tested about HIV infection and transmission risks," Anderson said.

The American Civil Liberties Union issued a statement saying it opposes the CDC recommendations because they call for discontinuing pre-test counseling and written consent. Rose Saxe, an official with the ACLU'S AIDS Project, said removing these safeguards could transform routine HIV testing into "mandatory testing."

A number of states, including New York, have laws that require written consent and pre- and post-test counseling for HIV testing. CDC officials said they would ask those states to consider revising such laws to allow health care facilities to adopt the CDC recommendations.

In D.C., the Whitman-Walker Clinic, the city's largest private AIDS treatment facility, has said it supports the CDC's recommendations. Whitman-Walker officials have embraced a routine HIV testing program started by the D.C. Department of Health earlier this year.

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