HIV Testing and Informed Consent

OPB | April 10, 2008 midnight | Updated: Sept. 10, 2013 8:40 p.m.

Should regular HIV tests become standard medical practice?

How many hurdles should you have to jump through before getting an HIV test?

Unlike most STDs and other diseases, HIV tests in Oregon require a patient’s informed consent. These consent laws, which were enacted along with other restrictions in the 1980s and 1990s, were intended to protect the privacy of HIV/AIDS patients struggling with the stigma the disease still carries.

Recently, though, doctors have been looking at the nationwide disparity between the number of people getting tested and estimates of HIV-positive people. For example, according to state epidemiologist Sean Schafer, there are just under 5000 total reported cases of HIV in Oregon. But he estimates that there are another 1700 or so Oregonans living with HIV today who don’t know it. What’s worse, those unknowing carriers are thought to be responsible for half of all new cases.

To address these kinds of disparities, the CDC released a new set of HIV testing recommendations in 2006:

  • HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed, unless the patient declines (opt-out screening).
  • Persons at high risk for HIV infection should be screened for HIV at least annually.
  • Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.
  • Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings.

Oregon and Washington are currently talking about implementing the CDC’s recommendations. But some members of the HIV/AIDS community are concerned about potential changes to the informed consent laws. For starters, they believe that signatures before testing allow for more patient control. And they worry about questions of privacy, inadequate (or non-existent) pre-test counseling, and insufficient resources for the disproportionately high numbers of HIV/AIDS-positive citizens without health care.

What’s your experience with HIV testing? If a stigma does persist, is it too early to drop informed consent restrictions? Is it possible to streamline a testing process while maintaining the care and counseling that many patients might need after receiving a positive result? Is Oregon’s health system capable of supporting a large number of newly tested, uninsured HIV+ patients — and is any answer to that question a good enough reason not to encourage more testing?

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