3. Promoting HIV Testing in Diverse Populations
Impact of State and Local Laws and Regulations
Forty-five states and the District of Columbia now have regulations regarding routine HIV testing that are consistent with the 2006 CDC recommendations, and the state of Delaware has adopted routine opt-out testing for pregnant women only.
Each state—as well as some local governing bodies—has enacted laws and regulations concerning the procedures for informed consent for HIV testing. These can vary in terms of how permissive or restrictive the procedures at individual facilities can be. Therefore, no general description of state and local regulations can be formulated. However, several national resources are available to assist practitioners in becoming familiar with the laws that are applicable to their own practices:
- The HIV section of each state’s health department website, with links [CDC State Health] provided by the CDC: www.cdc.gov/mmwr/international/relres.html
- The directory of the National Alliance of State and Territorial AIDS Directors [NASTAD]: http://nastad.org/statedirectory.aspx
- The National Clinicians’ Consultation Center directory of state HIV testing laws [NCCC State]: www.nccc.ucsf.edu/consultation_library/state_hiv_testing_laws
- The National HIV Telephone Consultation Service: 800-933-3413
The CDC recommendations themselves suggest that “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.” [Branson 2006] The recommendations also suggest that pre- or posttest “prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in healthcare settings.” [Branson 2006] On the one hand, use of a separate HIV consent form can increase the time and cost associated with testing and can pose a barrier to testing more patients. On the other hand, pretest HIV counseling and other interventions are associated with safer practices and reduced risk behaviors.
Nevertheless, practitioners should inform patients that they will be tested for HIV infection and should offer them the choice of opting out of testing. By telling patients that HIV testing is routinely offered to every patient, practitioners can help reduce the stigma that may be associated with testing and can assure patients that they have not been individually targeted for testing. Practitioners should further inform patients that knowing HIV status can benefit their own health as well as that of their sexual and needle-sharing partners and their communities.
