The U.S. Centers for Disease Control and Prevention (CDC) recently recommended making HIV testing a routine part of medical care for adolescents and adults. The new guidelines call for HIV screening of all patients aged 13 to 64 and all pregnant women—not just those at high risk—in all health-care settings. CDC previously recommended screening only for people at high risk and in settings with an HIV prevalence above 1 percent. “The [new] recommendation, if fully implemented, could mean testing for 100 to 200 million Americans, said Ron Spair, chief financial officer of Pennsylvania-based OraSure Technologies, one of three companies that sell rapid-result HIV tests in the United States,” the Associated Press reported.
CDC’s revised recommendations stress that HIV screening should be voluntary. However, unless the ethic of written, informed consent is upheld in all health-care settings, there are no assurances that patients will be fully aware of their right to reject the screening. Citizens and state and federal policymakers should carefully monitor HIV and other medical-diagnostic laws and policies to ensure that written, informed consent is obtained from individuals before any medical testing is performed.
The CDC’s report “Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings” stresses that “Patients should be informed orally or in writing that HIV testing will be performed unless they decline (opt-out screening). [Emphasis added.] Oral or written information should include an explanation of HIV infection and the meanings of positive and negative test results, and the patient should be offered an opportunity to ask questions and to decline testing. With such notification, consent for HIV screening should be incorporated into the patient’s general informed consent for medical care on the same basis as are other screening or diagnostic tests; a separate consent form for HIV testing is not recommended…. If a patient declines an HIV test, this decision should be documented in the medical record.”
The recommendation that patients can be informed orally increases the likelihood that overworked health-care providers could neglect to fully inform all patients that they are being tested for HIV. That is why written, informed consent should be obtained from all patients, including pregnant women, explaining clearly that 1) HIV testing is recommended as a routine medical test and 2) individuals are free to decline without penalty. This is especially important for patients who lack a full understanding of their legal rights regarding health-care matters.
- “Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings,” CDC’s Morbidity and Mortality Weekly Report (Vol. 55/RR-14), September 22, 2006: http://www.cdc.gov/hiv/topics/testing/resources/reports/pdf/rr5514.pdf.
- “HIV Testing for All, U.S. Agency Says,” by Mike Stobbe, Associated Press, September 21, 2006: http://www.lasvegassun.com/sunbin/stories/text/2006/sep/21/092102371.html.