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Routine Testing for the AIDS Virus
Editorial New York Times
2006-09-27

Federal health officials took the right step last week when they recommended that all teenagers and all adults up to the age of 64 be tested for H.I.V. infection when they receive routine medical care. This welcome effort to remove barriers in the way of widespread testing offers the best hope to reduce the stubborn persistence of H.I.V. infections in the American population.

Long after the AIDS epidemic burst onto the American and international scenes, it is a public health scandal that some 40,000 Americans are still newly infected each year that a quarter of those with the disease, or some 250,000 Americans, dont even know they are infected and that more than 40 percent of those who find out they are infected are tested only because they are already seriously ill.

Surely it would be better for every infected individual to learn of his status as early as possible, so as to plan the best course of treatment and avoid spreading the infection. And surely it would be better for community health if hidden chains of transmission could be detected and interrupted to slow the spread of infection.

In the early days of the AIDS epidemic, the disease carried such a stigma that people shied away from being tested lest they be socially ostracized or suffer discrimination. Patient advocacy groups pushed hard for policies to limit how testing was done and make sure all patients were counseled on the ramifications, both good and bad, before consenting to let their blood be tested. But times have changed. New treatments make it valuable to learn whether someone is infected. Health officials have shown that they can be trusted to keep test results confidential. And AIDS seems less stigmatizing.

The Centers for Disease Control and Prevention, which issued the new recommendations, urged that testing remain voluntary. Its most controversial proposal was that patients no longer be counseled extensively in advance about the pros and cons of testing and asked to sign a separate consent form. Oral notification and consent would suffice.

Some patient advocates worry that doctors will shortchange the oral consent process. But requiring a separate written consent for H.I.V testing beyond the general consent forms signed by patients all too often scares patients away from a test that would help them. A similar policy has greatly reduced the infection rate in newborn children. It is time to apply that approach more broadly.

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