A law signed by Governor Tom Corbett this week will allow for “opt-out” HIV testing in Pennsylvania.
The law drops the requirement that patients give written consent before being tested, and allows clinics and hospitals to include an HIV test with routine medical care unless patients explicitly decline. It also drops the requirement for pre-test counseling, and post-test counseling in the case of a negative result.
It brings Pennsylvania closer in line with Centers for Disease Control HIV testing recommendations issued in 2006 and already adopted by most other states.
Dr. Marla Gold, dean of Drexel University’s School of Public Health, said based on evidence from other states, this should increase the number of HIV cases identified.
“This amendment revolutionizes things in the state of Pennsylvania,” Gold said. “It will make available testing, and therefore make available what could be life-saving treatments, to people who otherwise currently wouldn’t know about (their HIV status).”
The old laws governing HIV testing in Pennsylvania were written when there was no effective therapy for the disease and a huge stigma attached to it, Gold said. Protecting patients and their confidentiality was key, so HIV tests were not treated like other screenings. Now, public health officials are trying to make the test more mainstream.
“I think the only way really to get at stigma is to make something so routine that Americans get used to it,” Gold said.
The CDC recommends HIV testing for everyone aged 13-64. New Jersey has encouraged its physicians and emergency rooms to adopt an opt-out policy since the CDC’s 2006 recommendations. Dr. Sindy Paul, medical director for the division of HIV, STD and TB services at the New Jersey Department of Health and Senior Services, said the goal was to integrate the test into everyday care.
“As the provider is talking to you about whatever your chief complaint was that brought you in,” Paul said, “saying We need to do some tests on you, as long as we’re going to test you for X, we could also test you for HIV’.”
Paul said since 2007, the rate of HIV testing at New Jersey HIV testing and counseling centers has increased by fifty percent, partly due to adopting opt-out policies and partly due to an increase in rapid HIV testing methods.
The American Civil Liberties Union and other legal groups oppose the law, saying it disempowers patients and places the decision-making on doctors instead.
“HIV unfortunately still carries a significant stigma and requires a lifetime of care, so it’s important patients have all the information they need and they willingly take the test,” said Andy Hoover, legislative director for the ACLU of Pennsylvania.
Hoover said he worries that an opt-out system will make patients feel pressured to get tested or will allow them to be tested without their knowledge.