CDC proposals for HIV testing clash with state laws

By David Douglas

NEW YORK (Reuters Health) - Routine testing for HIV recommended by the Centers for Disease Control and Prevention (CDC) appears to be inconsistent with laws in many states, according to findings published in the medical journal PLoS ONE.

CDC recommends routine HIV testing for all Americans between 13 and 64 years old. This would eliminate previous requirements for written consent and pretest counseling, Dr. Leslie E. Wolf, who is currently at Georgia State University College of Law, Atlanta, and colleagues note.

However, they point out that "this approach may conflict with state requirements." In fact, most states have laws that require specific consent. Fourteen require written informed consent and 19 require oral consent. Eleven states require pretest counseling.

Because of such legislation, "the majority of states would need to amend their laws to permit routine HIV testing." For example, states that require disclosures of specific information during pretest counseling or the informed consent process "would need either to eliminate those disclosures or make them recommendations, rather than requirements."

However, the team found that "despite strong public health recommendations" to facilitate testing, "the trend in states that have amended their laws since 2004 has been to reaffirm requirements for pretest counseling and consent."

Given the continued stigma surrounding HIV, the investigators add, it is likely that a reasonable patient standard for informed consent "would require more information about HIV testing than is currently contemplated under the CDC's recommendations."

Wolf told Reuters Health: "We think a balance can be struck so that we can increase testing among those who are unaware of their status without losing the opportunity to engage in education about HIV and prevention."

"But," she noted, "we need a better understanding of what's happening in the states when they consider changing testing laws."

SOURCE: PLoS ONE, October 2007.