Implementing Routine HIV Testing: The Role of State Law

Abstract

In September 2006, the Centers for Disease Control and Prevention (CDC) recommended routine HIV testing for all Americans aged 13–64, which would eliminate requirements for written consent and pretest counseling as previously required. However, this approach may conflict with state requirements concerning pretest counseling and informed consent for HIV testing. Our survey of state HIV testing laws demonstrates that the majority of states have HIV testing requirements that are inconsistent with the CDC's recommendations. Moreover, states that have recently amended their laws have not eased the requirements for pretest counseling and informed consent. The reasons for the persistence of these legal requirements must be understood to effect policy changes to increase HIV testing.

Provider-related Barriers to Rapid HIV Testing in U.S. Urban Non-profit Community Clinics, Community-based Organizations (CBOs) and Hospitals

“…Other research has examined the feasibility of using videos to present basic testing information, with the goal of reducing provider burden; in one study, patient comprehension of rapid testing was similar for emergency department patients exposed to either in-person or video information sessions (Merchant et al 2007). Nevertheless, in many states, significant legal barriers exist to revising counseling and consent protocols as suggested by CDC recommendations; for example, 11 states require pretest counseling, two of which require face-to-face counseling, and 14 states require written informed consent (Wolf et al 2007). …”

Recent Developments in Health Care Law: Partners in Innovation

“…Despite changes in the epidemic, most notably the development of highly active antiretroviral treatment (HAART), which has dramatically improved the prognosis of those infected with HIV, testing policies in the United States have remained largely unchanged (Wolf et al 2007). In 1999, the Institute of Medicine (IOM) published its recommendations for routine testing of pregnant women based on study results demonstrating that mother-to-child transmission of HIV could be significantly reduced if the mother received antiretroviral therapy during pregnancy and delivery and the baby received antiretroviral therapy after birth (Stoto et al 1999).…”

“…The CDC, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics endorsed the IOM's recommendations (American Academy of Pediatrics 1999; Centers for Disease Control and Prevention 2001). Nevertheless, few states changed their HIV testing laws to allow for routine HIV testing of pregnant women in the decade following these recommendations (Wolf et al 2004(Wolf et al , 2007.…”

Challenges Facing the US Hiv/Aids Medical Care System

“…The largest number of new HIV/AIDS cases occured between the ages of 35 and 39 years (16%), among black people (49%) and in males (73%). The estimated number of AIDS cases increased by 7% between 2001 to 2005 [1,2]. Trends in new infections and disease progression demonstrate that HIV/AIDS continues to be a problem in the USA and one that disparately impacts ethnic minorities and economically disadvantaged segments of the population.…”

“…Among them is that most states will require a change in their current laws to legally implement the recommendations. Currently, 14 states require specific signed patient consent documenting permission to carry out HIV testing and five of the 19 states that permit oral consent require that consent be documented [2]. Another challenge is that, apart from testing of pregnant women, routine HIV screening is not reimbursed by insurers because it is not currently recommended by the United States Preventive Services Task Force (USPSTF) [6].…”