CDC to Recommend Routine HIV Testing for U.S. Residents

CDC plans to recommend that physicians offer voluntary HIV testing to all U.S. residents ages 13 to 64 as part of routine medical exams in private practices, clinics, hospitals and emergency departments, the Wall Street Journal reports. The agency also plans to recommend revising current guidelines that require patients to sign informed-consent forms before receiving an HIV test and removing or condensing the requirements for pretest counseling, the Journal reports. Under current testing regulations, many states require individuals to participate in a 20-minute counseling session before obtaining an HIV test. In addition, people in some states must sign a separate informed-consent form, which details the risks and benefits of the test. Under the revised recommended guidelines, a physician could perform the test after receiving a person's oral consent. Physicians would discuss the results of the test privately with patients who test positive and perform a second test to confirm the results, according to the Journal. CDC's recommended guidelines are expected to be released in June or July in the agency's Morbidity and Mortality Weekly Report. CDC estimates that about 25% of HIV-positive people in the U.S. do not know their status. Many physicians believe that routine testing could lead to an earlier diagnosis and earlier treatment. Furthermore, a person unaware of his or her status might have "unknowingly infected many other people" (Chase, Wall Street Journal, 5/8).

Reaction
"What we want to do is to address barriers to testing in clinical sites," Kevin Fenton, director of CDC's National Center for HIV, STD, and TB Prevention, said on Friday at a news conference marking the 25th anniversary of the first diagnosed case of AIDS. He added, "We know that a barrier is the significant time it takes for pretest counseling. ... HIV testing outside clinical settings will still bear the requirement for pretest counseling." Timothy Mastro, acting director of CDC's Global AIDS Program, said, "These new guidelines ... recommend [changing] the nature of HIV testing so that it's not based on the risk to an individual or the community in which an individual resides, but routinizes testing of all people" ages 13 to 64 (DeNoon, WebMD Medical News, 5/5). He added that routine testing could reduce the stigma that is associated with undergoing an HIV test. Wendy Mariner, Boston University professor of health law, called routine testing "a double-edged sword," adding, "It's valuable to alert people to availability of treatment. But critics worry routine testing could slide into testing without knowledge or consent. That's not what's intended, but it's a legitimate concern." In addition, some critics say that loosening informed-consent requirements might lead to the unfair treatment of some groups, such as women and minorities. For example, some critics of routine testing say some people might feel forced to give consent, their consent might not be sought or the test might be given in a place where privacy is not maintained, according to the Journal. Both supporters and opponents of routine testing say that access to counseling and treatment is crucial to preventing the spread of HIV. According to Mastro, counseling, coupled with HIV testing, leads to a 68% reduction in risky behavior that could lead to new HIV cases (Wall Street Journal, 5/8).

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