Should Mandatory HIV Testing Be the Norm?

(CBS)  After nearly three decades of fighting HIV/AIDS, more than a 140 people in the U.S. are still being infected with the virus every day.

Monica Sweeney of New York City's Department of Health says the most at risk of getting HIV have limited access to medical care and don't find out they are infected until they already have full blown AIDS.

"That means for eight to 10 years they have been giving out HIV, having behaviors that transmit it and many times without their knowledge," Sweeney said.

To combat that, the Centers for Disease Control recommends identifying new cases by systematically testing every patient who steps into an emergency room. But New York and nine other states are in direct conflict with those guidelines. They mandate what's known as "informed consent," which means health care professionals must explain the test and get the patient's signature, reports CBS News correspondent Priya David.

Saint Vincent Hospital's Dr. Antonio Urbina has been pushing for testing reform because he says informed consent has become a barrier to stopping the virus.

"Anything we can do to normalize testing will increase patients accepting HIV and increase our ability to diagnose it," Urbina said.

But some advocacy groups say informed consent doesn't prevent testing, rather, it helps patients understand their treatment options if they test positive.

"Just saying to someone 'Here's a test, here's a result,' does not make them go into care, does not make them disclose who they are sexually involved with or change behavior," said Marjorie Hill, the CEO with Gay Men's Health Crisis.

But a few hospitals, like one in the Bronx borough of New York have found a way to work within the current rules, and even use modern technology to vastly increase the number of patients tested.

Patients give information through a computer - and doctors say patients feel more comfortable this way.

Since Jacobi instituted its streamlined program and added the computerized consent form three years ago, it's tested more than 26,000 patients and diagnosed 150 with HIV.

"We are finding positive patients who are unaware of their disease status," said Dr. Yvette Calderon, with the Jacobi Medical Center in the Bronx. "That's huge."

A bill to eliminate written informed consent was recently introduced in the New York State legislature.

[yoski99]

C/mon people..The virus has a half-life when exposed to air measured in microseconds therefore it's damned difficult to get infected UNLESS it's with an open wound and/or intravenous. FURTHER, there are now non-invasive screening tests that require only a swab of the gum with a q-tip like swab and results are less than 20 minutes. It's like the pee test for pregnancy an can be done at home..

[fabrat1]

YES, the more people we test the better. I have raised my girls knowing that before having sex it's ok and preferable to see a current Dr. report on any std's and aids testing. If he can't provide it then he's not worth their time and trouble or the risk!! Believe it or not my 21 year old asked her last b-friend for that info and he refused. Come to find out he had reason to believe he had an std from his ex but had never taken the time to be tested. She dumped him within 5 minutes and never looked back.

[amc36]

I think it should be mandatory. However,people should be informed that the test is going to be given. The reason being that there will be some people that will substain from sex or make sure to use protection when they do. Some will tell their partners. I did like the comment about the tattoo though. That was funny. It is true that some would be so common but it would help for the ones who aren't.

[JoeyLatino]

This article by Priya David is wrong. The CDC HAS NOT called for "mandatory" HIV screening, anymore than healthcare reform calls for "death panels". This is shoddy journalism. The CDC advocates for general consent, just the same as other diagnostic non-invasive testing protocols with an "opt-out" provision.
The CDC's revised recommendations from 2006 are listed below:

"HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening)."

"Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing."

CBS should clarify their mistake.
The CDC link follows:

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm

[policywonkette]

FInally someone got it right! This has nothing to do with MANDATORY testing and everything to do with informing patients they are being OFFERED an HIV test.

In other words, the onus is on medical professionals to make the offer once consent has been obtained. The difference between this practice and what happens in the 9 states referenced in the story is those states mandate institutions obtain written informed consent SEPARATE from the general consent everyone signs when they go to the doctor.

Catchy headline, but mandatory testing is another issue entirely. CBS should correct this misinformation.

[omded]

When HIV starts getting spread by mosquitoes, rats, someone coughning in your face, using a contaminated drinking fountain, etc. then, and only then will it become a virus which is spread by involuntary means, and then, and only then, should we all be scared of it enough to force everyone to get tested for it.

Every means of contracting HIV is voluntary. If you choose to place yourself in a position where you can get poked by a needle, it's voluntary. Regarding blood transfusions, they're all tested for HIV. So, the only instance where HIV can be transmitted involuntarily is rape, and this would be a rational exception where forced testing of rapists should be the law.

It looks like there's a lot of argument regarding what is voluntary activity and what's not. So, let's agree to disagree, and, instead, just answer this question: How will forced testing solve anything? The people who test positive still must be willing to accept that they have HIV, and they need to disclose it to the people whom they can infect. So, what good is forced testing withtout some means of forced disclosure to follow a positive result? Perhaps a large "HIV" tatoo forcibly placed on the foreheads of all the forcibly tested people who test positive for HIV?

Without the tatoo, I'll opt to let people decide for themselves whether or not they want to be tested.

[squeakof2006]

I don't want to be forced to get tested without my consent! For the line of work I intend to do (teaching), I could understand being asked to be tested, and I would oblige, but to tell me I HAVE to be tested is nuts! What about the people who do test positive? What is done for them? Is the treatment that they came in for denied until they cough up names? If I'm not participating in activities that put others in danger, I shouldn't have to be forced to be tested. This violates my right to privacy.

[dumascracks]

Only if you are going to give Blood, Work in Schools, Hospitals, Places that serves food, Truck Drivers, Bus Drivers, Police Officers, Military "OPPS THEY ALREADY DO THAT", Doctors, Child Care, Banks, Drivers License, Airplain License, and of course, Mothers an Fathers of new Borns!
All others are required to stop drug use, unprotected sex, "Even if the person is of the same sex, SICK!", an when they Die, they are Burned and there ***** are pump in to deep wells that will be used for N Korea Nuke Testing, or better yet, sent to Mars an see what happens!!

[dumascracks]

***** = a*s*s*e*s*

[artorus]

Hell no.

[kueiW]

If americans need anything it should be mandatory IQ testing. Those with an IQ below average should not be allowed to vote. Also, people who are on welfare should also not be allowed to vote since they always vote for candidates that increase welfare benefits.

[ianlou]

Yeah, and why don't we change the vote to reflect the rest of the laws in America and allow the wealthy to have more than one vote! Perhaps they should have a vote for every one million in the bank. After all, they are better equiped to decide who runs our country, if they were not smarter than us, how did they get so rich?

[ianlou]

I wonder how many conservatives out there would say "yes" to this and have said "no" to Gun Registration.

Nothing like cherry-picking right to privacy laws.