to Urge Routine HIV Tests for a Broad Swath of Americans
Wall Street Journal
CDC is planning a sweeping revision of its HIV guidelines, urging doctors to offer voluntary testing to everyone ages 13-64, regardless of lifestyle or perceived risk for the disease. The agency will also recommend that patients no longer be required to sign an informed consent form before taking an HIV test, and it plans to suggest abolishing or shortening requirements for lengthy pretest counseling.
HIV testing would be bundled with routine screening tests such as those for blood glucose and cholesterol as part of standard care in doctor's offices, clinics, hospitals and emergency rooms. Under the plan, a doctor would orally offer the test, and a patient's oral consent or refusal would suffice. A patient who tests positive would be taken aside for private consultation. A confirmatory blood test would be conducted to rule out a false positive, and if still positive, the patient would ideally receive more detailed counseling
about prevention, care and treatment.
Details of the new guidelines are expected to be published this summer in the agency's Morbidity and Mortality Weekly Report. Though CDC's recommendations do not have the force of law, they do provide doctors and insurers a new standard for care and reimbursement.
According to CDC officials, the goal is to simplify the HIV testing process in order to reach more infected people earlier. CDC estimates that around 25 percent of the 1 million Americans with HIV are unaware they are infected, and some of those people are diagnosed only when the virus has progressed to AIDS. CDC says more than half of new HIV infections are believed to be transmitted by people who do not know
they are HIV-positive.
Some patient advocates are concerned that routine universal testing without written informed consent could lead to coercion. That is especially true for women and minorities, said Catherine Christeller, executive director of the Chicago Women's AIDS Project, one of 54 groups that wrote to CDC to voice opposition to ending informed consent. Others worry about privacy breaches or loss of insurance or employment. The recommendations would be contingent on the revision of state and local laws requiring written informed consent, a process that could take years.
The development of rapid HIV testing and more effective treatments mean people have more to gain by knowing their status, says CDC. Though she supports broader testing, Rochelle Walensky, an AIDS researcher and assistant professor of medicine at Harvard University warns that if someone who tests positive is not linked to care, "then you've found the needle in the haystack only to throw it back."
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