A recent public hearing in Seattle examined proposed changes in Washington State's rules governing HIV counseling and testing. State and local officials say many physicians and patients balk at the 30-plus minutes of counseling required before and after each test.

The state's rules on counseling were written in 1988 - when many physicians and at-risk patients were not well informed about HIV - and list nearly 70 points a doctor must be aware of or tell a person being tested. The information must be conveyed even if the patient has previously tested, and patients must sign informed consent forms apart from the general informed consent given for other tests.

Doctors have been "quite vocal" about the requirements and the 46-page state counseling guide they are supposed to study, said Dr. Bob Wood, AIDS control director for Public Health Seattle & King County. Wood and some other public-health officials would prefer that HIV testing be offered routinely in emergency rooms, as studies have found that emergency patients in large trauma centers have a high prevalence of HIV. However, Dr. Scott Barnhart, medical director of Harborview Medical Center, said ER workers can barely keep up with patient load, let alone provide the required HIV counseling, which he said "can be more cumbersome than what we give for heart surgery."

The new rules would cut pages from the required information and direct doctors to assess the patient's "unique circumstances" in providing counseling; allow a previously tested person to decline extensive counseling; call on health workers to help the individual "set and reach a specific and realistic behavior-change goal" to reduce the chance of transmitting the infection; and eliminate the need for separate consent. Other public hearings on the changes will be held before a final decision is made in the fall.