CDC recommends routine HIV tests: no informed consent or pretest counsel

ATLANTA -- Testing for the AIDS virus could become part of routine physical exams for adults and teens if doctors follow new U.S. guidelines expected to be issued by this summer. Federal health officials say they'd like HIV testing to be as common as a cholesterol check...

Under the new guidelines, patients would be tested for HIV as part of a standard battery of tests they receive when they go for urgent or emergency care, or even during a routine physical...

There would be no consent form specifically for the HIV test; it would be covered in a clinic or hospital's standard care consent form. Patients would be allowed to decline the testing...

The new recommendations, as currently drafted, do not require pre-test counseling. They call for post-test counseling to be offered only to patients who test positive. CDC officials say they understand advocates' concerns, and are optimistic physicians will follow the recommendations carefully.


http://seattlepi.nwsource.com/health/1500AP_HIV_Testing.html

would you change your behavior to protect others? Sounds like a simple question, but, there are some fatalistic attitudes out there.

this may be a case where the public interest is greater than personal privacy concerns. In any case, doctor-patient confidentiality should still apply right?

Except for states which require the reporting of names.

I don't know what you mean about the greater public interest, there are no quarantine measures included in the recommendations. Yet.

Do you mean the state is simply informed or are those names printed publicly. And what states?

State privacy laws are only as strong as the legislatures' will to uphold them. States can, and do, change their laws regarding privacy all the time. If a state Health Department has a name-based registry listing people with HIV, it can be forced at any time to open that registry by either legislative mandate or court order.

http://www.actupny.org/reports/myths-names.html

for individuals to know accurately know whether or not they are infected. I'm not proposing publicly listing HIV-positives, I'm just saying a distrubingly high number of those infected are not aware of the infection. Early treatment and the preventation of further infections are in all our interests. If confidentiality is upheld this would be a great public good. If it is not it becomes more problematic, and issues of privacy and civil rights must be weighed.

To the point: The states that require the reporting of names, how are these lists used? If used for an attempted murder charge against a prostitute that continues plying her trade even if infected with AIDS, it could be considered quite appropriate to use the database as evidence. If used to deny someone employment then it is inappropriate. Are there cases of abuse of these systems?

There are 40 million infected with HIV worldwide, while 350 million are infected with Hepatitis C. Why only test for HIV?

More so, why test someone without their consent?

Take HIV out of the equation.

We have mapped the human genome.

Would you want the government to tell you that you should not procreate because you have the ability to pass on, diabetes, alcoholism, prostate cancer, homosexuality, blond hair...?

advocate is dropping the separate HIV-specific consent and counseling requirements in place for HIV testing. i.e., CA law requires the HIV specific consent, and CA Office of AIDS funded testing requires pre and post test counseling. The CDC is saying that listing HIV in a standard consent for routine blood work and allowing an "opt-out" may increase the number of people testing and, of course, the number of people who are aware of their status. While I have mixed feelings about it, I see CDC's point. In the big picture, it's important that as many people as possible know their HIV status, even if that's provided without the risk reduction counseling CA Office of AIDS funded programs currently provide.

What I do not trust this administration with is what they would do with the names of people who test positive.

Who knows? Sex, tainted transfusions, and intravenous drug use aren't the only ways one can contract HIV. You can also get it if you've been involved in a bloody fight or accident with an HIV-infected person, even though it's rare for that to happen.

That's what I think anyhow.

but whether or not the option to opt out would be in plain view or in the fine print is a good question.

No.

When you get a CBC (a Complete Blood Count) you aren't tested for any virus, bacteria, fungus or protozoa.

Many of these germs you can pass on to anybody you encounter.

Why the focus on HIV????

What about all the other sexually transmitted diseases?

This is total bullshit.

We could sit here and come up with very specific situations in which we think HIV could be transmitted.

Guess what? Most likely won't happen.

disease.

The President isn't supposed to wiretap illegally, either.

Of course it's ok.

It's odd that they could test you for something without your consent.

There are 350 million people infected in this world infected with Hepatitis C. Why none of the attention? Not to mention, it is easier to transmit HCV than HIV. But HIV, or "AIDS" as the media loves to inaccurately refer to this virus, is used more as a scare tactic.

at all.
The information will make it's way into a database, thus making hundreds, if not thousands, of people uninsurable and/or unemployable.
MANY people that test positive for HIV NEVER develop symptoms of AIDS.
It should remain, as it is, a voluntary SEPARATE screen done under informed consent.

and an AIDS diagnosis.

Long term non-progressors are the group of people you speak of.

I would love to do a poll on here to see whether or not people at DU think you can "get AIDS' from someone. You can't. The first line of this article made me gag.

The fact that the CDC is considering this is disgusting.

After an accident. One of the medical personnel had a possible contamination event and demanded that she have an HIV to assure that he would not be infected. My mother thought that such a request was ridiculous as her mother was over 70 and married and monagamous for around 50 years. She consented anyway. I don't know if perhaps this is part of the issue to wanting regular HIV tests. Medical personnel are supposed to take universal precautions anyway, but I wonder if they act/would act differently knowing HIV status.

since it can take a bit for infection to show between being infected and test coming back positive, we are supposed to treat everyone as positive. Another big problem, more easily transmittable than HIV, is the nasty Hep C which has led many of us to do universal percautions all the time.

Some health care people treat all the same, some more careful when they know for sure, some the same amount of carefulness.

However, you show me a latex glove that can stop a needle from penetrating it.:eyes: Or perhaps how gloves/gowns etc. can prevent a patient from scratching/biting/spitting?
In the early 90's, AIDS was relatively new on the horizon for many medical personnel. We didn't know exactly how it was transmitted--in fact, at that point, many people that had AIDS were put in complete isolation.
However, as we began to know more about the disease process, we found that most of the isolation procedures were unnecessary and have since relaxed them.
Your impression that the medical person DEMANDED that your grandmother be tested is a little off base. Every hospital has policy and procedures in place in the event of a needlestick. This includes having the medical personnel tested for HIV/Hepatitis and the patient tested for the same to obtain a baseline.
In fact, do you know that Hepatitis B is a worse offender than HIV for medical personnel and isn't transmitted sexually? It is possible that your grandmother had a blood transfusion and both of these diseases are transmitted by blood. It isn't just about sexual activity.
Trust me--it wouldn't make a difference knowing a patient is HIV+ in how the patient is taken care of. Most healthcare providers understand the threat that every patient is a potential carrier.
Needlesticks are a hazard of my job. I've been stuck twice in 20 years. I've been very lucky that nothing came of it. I wasn't careless and I used universal precautions. Sometimes it just isn't enough when dealing with patients who have the potential to be combative and/or disoriented.

Let alone biting or scratching?

The infection rates for HCV and HIV are less than 1% in a healthcare setting. With HIV, there are prophylaxis in place in case of exposure.

but in the early 90's we really weren't sure.
I was addressing the OP in the time frame she claimed this happened.

You also state that Hepatitis B is not sexually transmitted. HBV, is in fact, considered a sexually transmitted disease. It's transmitted a lot of the same ways HIV is, the only exception being that HBV is not transmitted through breast milk.

If you are being sarcastic about HIV being transmitted through scratching, biting, or spitting, than I apologize for recognizing the sarcasm. There's still a lot of misinformation out there, and since I do this for a living, I just wanted to make sure we all had the proper information.

In most of the world, HIV policy has been mighty long on the "voluntary" and the "educational" and terribly short on anything resembling effectiveness. Widespread routine testing and reporting should have been instituted long ago. There is no "right" to spread deadly diseases, whether sexually transmitted or not.

So how would mandatory testing stop it?

And mandatory reporting, contact tracing, and control measures are the other part.

Look, most people aren't psychopaths. If they know they are infected with a lethal virus, they'll avoid doing anything that might spread the disease to uninfected persons. They deserve support.

But for those who just don't give a shit about anyone else, quarantine is appropriate. It works with TB, and a slew of other communicable diseases.

"Put them all on an island together." I was 8 years old and remember hearing him say this crap while watching the nightly news with my folks.

And why stop at HIV? There are a myriad of other transmittable diseases, sexual or otherwise, that an individual can transmit to others. Why not test for those as well?

... and not only in the case of HIV. Those persons who are infected and yet who insist upon putting others at risk need to be controlled.

like to see quarantined?

Are you actually saying that people with HIV should be quarantined? This example you state in your post is not the norm. It rarely happens. But the media sure as hell likes to play it up.

Boo!

Should smokers be quarantined because it has been shown that second hand smoke can cause cancer?

You ignore the fact that exposure is different than transmission. Many people have been exposed to the virus and don't get infected. You are more likely to get infected with Hepatitis C then HIV when exposed. Why, then, is there more attention given to HIV?

In an ideal world, more people would be educated about transmission, but sadly, there is still soo much misinformation out there. There is a scare tactic in the media when it comes to HIV, or as the media wrongly refers to this virus as AIDS.

There are laws in some states that prosecute persons who are aware of their infection and still engage in high risk behavior and infect their partners. Does this make you happier? Or do you still prefer isolating HIV+ people?

So, controls might be warranted in the case of a disease that is spread through coughing (because its victims are mostly infected in the course of an "innocent" activity like breathing).

But similar action is not warranted in the case of disease that is mainly spread through sex, because those who catch such a disease were engaged in a not-innocent activity, and must have known they were taking a risk, and really only got sick as a result of their own choices... Not at all like those blameless ones who were merely breathing when the pathogen reared its ugly little viral head, eh?


That's actually pretty moralistic -- and distasteful -- if you think about it. And it has always surprised me that so few people seem to notice it.

Should smokers be quarantined because it has been shown that second hand smoke can cause cancer?

Increasingly, they are. Smoking is not allowed in many public places now. Designated smoking areas, court-issued bans on smoking around ones children, and such can amount to a quarantine of sorts.

You ignore the fact that exposure is different than transmission. Many people have been exposed to the virus and don't get infected. You are more likely to get infected with Hepatitis C then HIV when exposed. Why, then, is there more attention given to HIV?

I ignore it because it changes nothing. We don't sanction drunk drivers only when they happen to smash into someone. Reckless conduct -- exposing others to a readily foreseeable risk of serious harm -- may be judged impermissable even in the absence of physical injury.

(Oh, and I don't object to appropriate vigilance re Hep. C. Did you think I would?)

There are laws in some states that prosecute persons who are aware of their infection and still engage in high risk behavior and infect their partners. Does this make you happier? Or do you still prefer isolating HIV+ people?

Some individuals cannot be trusted, and therefore need to be subject to some sort of control.

You do bring up some interesting points which I would love to address. But you still haven't answered some of my previous questions.

"quarantine is a reasonable measure to take with some individuals and not only in the case of HIV."

Hazawhaza...what??


How am I being a "covert moralist" by stating that TB is spread by coughing and HIV is not?

You kind of make no sense in your posts, IMHO.

"But similar action is not warranted in the case of disease that is mainly spread through sex, because those who catch such a disease were engaged in a not-innocent activity, and must have known they were taking a risk, and really only got sick as a result of their own choices..."

Who are you to say that sex is "not-innocent activity"?

Can you please define what "not-innocent activity" is?

should quarantine those who are infected.


***Everyone, please read everything that NorthernSpy said in this thread about "quarantine"***


You said something that was reckless by comparing HIV to TB.

Your strawman was that there are people out there that recklessly infect others with HIV while they are positive.

Bullshit. Rarely happens. Crap upon a craptastic piece of poo.

While we are at it, let's quarantine carriers of genetic diseases as well.
If two carriers of let's say, Cystic Fibrosis procreate, then the child that is born is doomed to a life of sickness and/or death.
So if we quarantine all of the carriers of JUST CF, we can eliminate a lot of pain and suffering to the children of these carriers. We can also save a lot of money because, as parents that have children that have CF will tell you, it is very expensive.
OR
we could spend the money on education and resources instead of incarceration.

BTW, your HIV+--don't give a shit--infect everyone I can--strawman is a very rare animal. I'd tend to say that I would be more concerned about the idiots who habitually drink and drive or drive recklessly. You are more likely to come into contact with one of them than YOUR strawman.

then perhaps the stigma would not have been attached and that would have been possible.
But when a majority of the population does not understand the differences between HIV and AIDS, and the transmission, and the populations affected...and instead equate it with a disease that only promiscuous people get, it becomes nearly impossible for people to be completely honest about their HIV status for fear of losing their jobs, insurance coverage, friends, etc.
Remember Ryan White? That is the reaction that too many people still have to people with AIDS.

If Reagan had given half a shit about the issue, maybe something could have been done. Far too late now.

... for wasting twenty-five years on ineffective policies that helped to grow an epidemic.

Even worse was the exporting of the whole voluntary/educational/'personal empowerment' paradigm to the Third World. Those countries should have followed the Cuban model (to whatever extent they could) from day one. They might have had a chance then.

An AIDS diagnosis was enacted in the early 90's for two reasons: tracking and benefits.

An AIDS diagnosis, which I hope more people at DU would understand, relies on one of three things happening:

1)One or more opportunistic infections
2)CD4 cell count falling below 200, and
3)CD4% falling below 14%.

It's a diagnosis that the government uses to figure out who needs benefits and for disease progression. And any of these three things can happen, and then you can bounce back. But you will still have an AIDS diagnosis for benefit reasons.

Having an AIDS diagnosis doesn't mean that you're about to die.

AIDS is not a virus, but I've seen a lot of DU'ers use an AIDS diagnosis interchangeably as the same thing as HIV. They are separate.

And you are SO RIGHT that most of the population doesn't understand the difference between HIV and AIDS, let alone transmission and which populations are affected. I'm still amazed that in my line of work some people think that HIV is air born. Don't laugh. That myth is still out there.

I was pregnant with Material Girl and they tested me for HIV as well as drug use without my consent. Yep, you saw that right, WITHOUT my consent or my knowledge.

I only found out because I fired the OB and demanded a copy of my records. When I reviewed them I was horrified at the stuff that was in there about what a "difficult" patient I was because I asked a lot of questions. THEN I got to the part that had all my test results and found that they'd done that tox screen and that HIV test without even telling me...

I researched it and found that (at that time) it was illegal to do that HIV test without my consent. The penalty for the provider was something obscenely low like a $500 fine. I filed a bunch of complaints with anybody I could think of, and left it at that. Partly, that was because I talked to a few attorneys who all told me that pregnancy pretty much removes all your rights to privacy.

I have NO idea what the laws are like now.


Laura

You have every right to now what tests are being done on you.

I do health literacy education, and the fact that the Dr. documented you as "difficult" because you asked questions about what they were doing to you without informing you makes my blood boil.

We're paying their rent, so we should be able to sit there and ask questions for as long as we want.

HIV testing is routine during pregnancy. Last year at my first ob appointment I had all the required blood tests (Hep., syphillis, HIV, and whatever other things they can test for). I had to sign a consent form but was told that the tests were mandatory (but don't think they are in all states). Cystic Fibrosis testing is also routine during pregnancy. If the mother is a carrier, the father is tested. I don't even remember all the screening tests I had during my pregnancy, and I even declined many of the non-mandatory tests, that is, genetic screening tests and invasive genetic testing. I also declined seeing the genetic counselor even though I was considered high risk because I am an older mother (in my 40s) - I was described as "elderly" in my medical records. Of course, my baby is just fine!

Inaccurate reporting once again from the media.

One can only get HIV, which, by name, is a virus. From what we know, HIV can lead to an AIDS diagnosis.

No one gets tested for "the AIDS virus". In fact, no one get AIDS from anyone else. One gets initially tested for the antibodies that our immune system produces in response to having the HIV infection.

And if there is a HIV infection, we monitor the CD4/T-cell count (the cells which HIV uses to reproduce, and then kills) and HIV viral load.

AIDS is a diagnosis. And just because you have an AIDS diagnosis doesn't mean that you are in a late stage disease progression.

So much misinformation out there. I wish the media would stop using HIV and AIDS interchangeably.

The original banner was indeed about "AIDS tests".

The first line of the article,

"Testing for the AIDS virus could become part of routine physical exams..."

has bugged me all day. We're all good, Bluebear.

:toast:

I wasn't bristling at anything you said either, just pointing out that the original media information on this story was flawed. Thank you for all you do with educating people.

Testing an individual without consent goes against everything we aspire to be as a democracy.

and seeing your position I'm forced to ask: Are there any circumstances under which you might find involuntary testing and or quarantine acceptable?

I agree with most of your privacy and civil rights concerns, but you are taking an absolute position against the idea. Given the potential damage the HIV virus may cause unchecked, what measures beyond just educational and voluntary action are acceptable?

If you'll forgive the straw man, would it be appropriate to test inmates in prisons for HIV and separate out those infected? Given the realities of prison life would it be fair to other inmates to allow an infected inmate into the general prison population? Are there any circumstances where forcing testing and separating out individuals based solely on infection presence?

Given the amount of misinformation out there, the stigma involved, etc., I feel that mandatory testing and subsequent name reporting is more dangerous to the individuals involved than to the general public.

Databases are not secure; moreover our government has displayed little respect for civil liberties. Under the circumstances, I think it is a frightening prospective.

I am a regular platelet donor