April 7, 2009
In an effort to improve screening for and diagnosis of HIV infection, CDC released its "Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Health-care Settings" in September 2006. These guidelines call for all patients ages 13-64 in health care settings to be offered HIV screening on an opt-out basis, without separate written consent and prevention counseling. However, state laws addressing HIV testing are widely assumed to be a barrier to the implementation of these recommendations.
In order to help policymakers and providers better understand their own legal context and to correct possible misunderstandings about statutory compatibility, the researchers undertook a state-by-state review of all laws pertaining to HIV testing. The review, which included Washington, D.C., systematically assessed the consistency of these laws with the new recommendations. The state regulations were classified as consistent, neutral or inconsistent with the new regulations. The review also examined the implications for implementation of the recommendations in theses various legal contexts.
The authors found that in 34 states and Washington, D.C., statutory frameworks were either consistent with or neutral to the CDC guidelines, which would thus enable their full implementation. In 16 states, statutory frameworks were found to be inconsistent with the recommendations. Barring legislative change, this would preclude implementation of one or more of the novel provisions of the recommendations. In the two years since the guidelines were published, nine states passed new laws to move from being inconsistent to being consistent with the guidelines.
"State statutory laws are evolving toward greater compliance with the CDC recommendations," the authors concluded. "Policymakers, provider groups, consumer advocates and other stakeholders should ensure that HIV screening practices comply with existing state law and work to amend inconsistent laws if they are interested in implementing the CDC recommendations," the authors concluded.