HIV Screening in Health Care Settings

On September 22 2006 the Center for Control and Prevention (CDC) issued a sweeping revision of its guidelines for human immunodeficiency virus (HIV) screening in health care settings that reversed a decade-old approach to AIDS policy. Previous guidelines recommended HIV testing only for persons at high risk or in health care settings with high HIV prevalence which reflected a civil liberties approach that constrained testing with costly cumbersome procedures for pretest counseling and written informed consent. Health care professionals often did not perform HIV screening due to financial or administrative burdens or because conducting risk assessments or discovering HIV prevalence in their facilities was impractical. The new guidelines which apply to all health care institutions in the public and private sectors (eg emergency departments inpatient services public health and community clinics primary care and correctional health care) represent a radical departure. The CDC now recommends HIV screening for all individuals aged 13 to 64 years as a part of routine medical care irrespective of lifestyle perceived risk or local HIV prevalence. The recommendations incorporate a concept known as opt-out testing which notifies all patients that testing will be performed unless an individual explicitly declines. Although the CDC guidelines do not explicitly indicate how patients should be notified about testing separate written informed consent would no longer be required but rather general consent for medical care would be sufficient. Similarly counseling would not be required with HIV diagnostic testing or as part of HIV screening programs. (excerpt)