Chicago Tribune Editorial - A routine HIV test

Chicago Tribune Editorial - A routine HIV test
Published October 7, 2006
Copyright © 2006, Chicago Tribune



When your doctor draws blood for testing, she generally doesn't tick off the entire list of tests that will be done. Maybe you're concerned about your cholesterol. Maybe it's something more serious--an STD or diabetes. A complete blood workup may encompass a dozen or more tests. But in Illinois and elsewhere, it won't include screening for HIV, the virus that causes AIDS, unless you specifically give consent. That means you have to sign a piece of paper and receive several minutes of pretest counseling about the decision to get tested.

The federal Centers for Disease Control and Prevention is urging states to change that. It wants to make HIV testing as routine as a cholesterol screening. The CDC's aim is to encourage testing of all patients between ages 13 and 64 when they visit a doctor's office or hospital. An estimated one-quarter of the 1 million Americans living with HIV don't know they have it.

A diagnosis of HIV need not be a death sentence. There are drugs to control the disease--and the sooner you know you have it, the better your chances of slowing the progress of the illness. Not only that, but studies show that someone who knows he or she is infected is far less likely to spread the disease. The CDC says that greater testing could help reduce the spread of HIV by more than 30 percent, since studies show that carriers cut back on high-risk behavior once they learn of the infection.

Implicit in the CDC's stance is this powerful notion: The stigma of HIV has faded so much that those who have the virus no longer need special protections.

But has it? Some who work in this field say that the stigma remains and that pretest counseling and other measures are crucial for those who receive this dreaded diagnosis. "This is a diagnosis that will turn your life upside down," says Ann Fisher, executive director of the AIDS Legal Council of Chicago. She's right, of course.

Some advocates agree with the CDC on more widespread testing, and even some streamlined procedures, but not the scrapping of explicit written consent from the patient. They fear the CDC's proposal will result in "stealth" testing--with people being screened without their full and written consent.

The CDC's proposal isn't binding, but it is likely to be highly influential. It's important to note that the CDC is not recommending mandatory screening. People could "opt out," or choose not to take it.

In Illinois, the law requires pretest counseling and that patients be informed of HIV test results face-to-face. That makes sense. Doctors and public health officials should encourage broader testing for HIV. It should be routinely recommended to those who have not been tested. But that should be done while preserving the counseling and reporting rules in place in the state.

The stigma of HIV-AIDS has diminished but has by no means vanished. An opt-out policy, if it were to be started, shouldn't be taken to mean that health professionals could dispense with the care and sensitivity people deserve when deciding to be tested--or learning they have HIV.