CDC
to Urge Routine HIV Tests for a Broad Swath of Americans
Wall Street Journal
Marilyn Chase
(05.08.06)
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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