Aug. 31, 2006 – HIV testing may soon become as routine as cholesterol screening if healthcare facilities comply with guidelines the Centers for Disease Control plan to issue in September.
The CDC currently recommends annual screenings for people with a "high risk" of contracting HIV. The Centers also recommend routine testing at clinics and hospitals serving areas where the rate of HIV infection is 1 percent or higher. But new draft guidelines, reviewed by The NewStandard, recommend routine HIV testing at any healthcare setting. The draft also asserts that two standards in HIV testing â€“ counseling people before they take the test and asking for written consent for the test â€“ are unnecessary and cumbersome to healthcare providers.
While no healthcare facility is obligated to follow CDC recommendations, medical professionals often make them standards of care. They also carry weight for health organizations that apply for CDC grants.
The CDC asserts that the new recommendations will help HIV-positive people learn of their status at an earlier stage, when treatment is more effective. The Centers also say increased testing will help reduce the spread of the virus. People who know they are HIV-positive are more likely to have safer sex, says the CDC, which cites studies indicating people who know they are HIV positive are 68 percent less likely to have unprotected sex than HIV-positive people unaware of their status.
"The CDC has been talking about testing as if itâ€™s a magic bullet and they have not approached closing treating and prevention gaps."
CDC spokesperson Jennifer Ruth said the recommended policies are designed to help healthcare workers as well. "The purpose of these changes is to eliminate the complexity â€¦of having to do risk screenings or studying prevalence rates," she told TNS, adding that eliminating requirements of separate written consent and pre-test counseling will help providers test more people.
Advocates for HIV positive people support increased testing, but argue that de-emphasizing counseling and written consent can be dangerous.
James DeDeaux is executive director of the South Mississippi AIDS Task Force, which serves six rural counties in the state. He said pretest counseling is important and should not be seen as a burden. While the CDC does not seek to eliminate counseling for people who test positive for HIV, DeDeaux and other advocates said doing away with pretest counseling could harm people taking the test, regardless of their HIV status.
"If youâ€™re not prepared for the results, how will you deal with this?" DeDeaux said. "If you havenâ€™t gotten counseling ahead of time to prepare you for an HIV-positive result, this could hit you like a brick."
Noel Alicea, a spokesperson for Gay Menâ€™s Health Crisis, a national AIDS treatment and advocacy group based in New York City, said counseling sessions are also valuable to those who test negative.
"Itâ€™s important so they know how to stay negative," he said, adding that in his experience, many people value the chance to talk about their health. "Counseling is not about the counselor telling them what to do." Instead, he said it is about "having a conversation about whatâ€™s happening in that personâ€™s life" and helping them make decisions on how to protect themselves.
Approximately half of people living with AIDS or HIV in the United States do not receive regular treatment.
DeDeaux is also concerned with the CDCâ€™s recommendation to eliminate separate written consent forms for HIV tests. Under the new draft guidelines, "general consent for medical care is sufficient to encompass consent for HIV testing," and testing will occur unless patients opt out. The CDC says healthcare providers will not have to gain signed consent and can simply inform patients about the test either verbally or in writing.
DeDeauxâ€™s concerns are echoed by Jim Pickett, public policy director of the Chicago AIDS Foundation. Pickett said under the new guidelines, people might not realize they are being tested for HIV.
But Ruth of the CDC defended the recommendation. "Certainly we are still supporting a voluntary testing approach with the patientâ€™s knowledge and understanding," she said.
But advocates like Picket say the stigma of an HIV diagnosis is still strong enough that a separate step is needed to ensure that patients know what they are getting tested for and the consequences of the results.
"Iâ€™ve had a lot of blood drawnâ€¦ but I donâ€™t necessarily say, â€˜What are you doing? What are the 15 things youâ€™re testing [for] here?â€™" Pickett said. "So unless consumers are extraordinarily paying attention, it will be easy for providers to throw [HIV testing] in."
Advocates say the CDC is using HIV testing as a panacea to the HIV/AIDS epidemic.
"The CDC has been talking about testing as if itâ€™s a magic bullet and they have not approached closing treating and prevention gaps," said Sean Barry, director of prevention policy for Community HIV/AIDS Mobilization Project (CHAMP).
"We have to look at what the real barriers are to testing."
According to a report released by the Kaiser Family Foundation, which studies healthcare issues, approximately half of people living with AIDS or HIV in the United States do not receive regular treatment. Each year, 40,000 people become infected with HIV, a rate that has not changed since 1990, according to the report.
The federal government has steadily increased its budget for HIV and AIDS in the past decade, but accessing timely treatment and drugs is still difficult, according to a report released by the National Institute of Medicine, a research organization that advises the federal government. The report said differences in eligibility requirements between states and uneven coverage are some of the reasons half the HIV-positive population does not receive treatment. The report added that universal health insurance is the ultimate answer to controlling an epidemic like AIDS.
Advocates said there are alternative ways to expand testing that maintain counseling sessions or written consent forms.
"We have to look at what the real barriers are to testing," Alicea said. "Is the barrier to sign a form or give consent, or is the barrier that people are afraid to find [out] their status or they think if they find out their status that theyâ€™ll encounter discrimination or rejection?"