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CDC Hints at HIV Testing...Without Consent

By August 17, 2009

In an effort to slow the spread of HIV, the CDC is suggesting HIV testing of emergency room patients without their consent. You heard right...without their consent. Many believe that informed consent actually is a barrier to getting people tested. In the US more that 150 people per day are still becoming newly infected. By normalizing testing, meaning treating HIV testing like any other blood test, many feel it will take the stigma of testing out of the process and people will get tested. However, others feel testing without consent means people will get results without any education as to what to do after testing positive. Advocates of informed consent feel it helps people understand their treatment options and gets them into medical care they may not get into if tested without consent. Supporters of mandatory testing say it will help identify those people unaware of their infection. Without knowledge of their infection, people continue to engage in at-risk behavior, placing others at risk for new HIV infections. Many states now require informed consent for HIV testing, however, one of those states, New York, now has a bill in their legislature that would eliminate the informed consent requirement. In a related story, the Veterans Administration (VA) are now offering HIV testing as part of all routine medical care and have dropped the written consent requirement. Is there a change in the wind?

What Do You Think?


So...what do you think? Should everyone who sets foot in their local ER be tested for HIV whether they want to be tested or not? Some would say it would be for the benefit of public health. Others may see it as a 1984 - like policy. What do you think?

Related Information

Comments
August 17, 2009 at 2:49 pm
(1) NatalieKita says:

sounds like a good way to add more unnecessary tests that run up healthcare costs and ER waiting times for all those in need of urgent care….not to mention eroding away personal freedoms…

If it would really make a significant difference, then I could MAYBE see the point a little bit…but with the precautions already in place, sounds like a waste of time, money, and resources.

August 17, 2009 at 2:55 pm
(2) Kristin Hayes says:

I agree that the cost of such a plan would be staggering. I also believe that the original rule that patients had to give consent for HIV testing stemmed from a stigma that is no longer present. I don’t think that consent for HIV testing is really necessary. Do I think everyone should be tested who walks through the ER? No, I think people should be tested after the doctor receives an accurate health history identifying risk factors, and determining that HIV may be a possibility for their current illness.

August 17, 2009 at 3:06 pm
(3) Erica says:

While I think it might be a good way to find some of those who are walking around with the disease and completely unaware, I don’t like the mandatory without consent part. I don’t think anyone should be subjected to medical testing without giving their consent.

Perhaps a happy medium would be OFFERING the test to anyone who walks into the ER as a standard operating procedure. Then is really is like a standard blood test with less stigma. But to force it? No thanks.

August 17, 2009 at 3:21 pm
(4) Lisa says:

Well, that would be the last time I ever set foot in an ER…not because I’m afraid of testing, but because I draw the line at mandatory testing without consent. There is absolutely no way that this is even remotely in the spirit of American freedom, and I’d be surprised if it wasn’t deemed unconstitutional.

I agree with Erica. Offering the test, great! I’m all for it. FORCING people to take it? No way.

August 17, 2009 at 3:22 pm
(5) Leah says:

I’ll agree with Erica and say offer it to everyone, but if we don’t want the ER to be primary care, we have to stop treating it like it is primary care. Informed consent should be mandatory for everything done to/offered to a patient. When we skip this step we are removing personal freedoms. If you’re having sex with someone who hasn’t been tested or you don’t know their HIV status, well that’s your right as well.

August 17, 2009 at 3:34 pm
(6) Pam says:

This would help protect ER staff, wouldn’t it? And it would help educate patients. ER visits usually involve some blood draws, I guess, so why not test some while the patient is right there? Might the results affect the treatment that is offered? I would be happy to be tested. Not sure what the cost would be. Is private pay health ins going to cover this? Hmm, without consent – why not just tell everyone? Patients can refuse, can’t they?

August 17, 2009 at 3:50 pm
(7) Suzanne says:

I agree with what others have commented – that testing without consent creates some very serious ethical issues. On the other hand, as a public health professional and someone who cares deeply about protecting public health, I believe there are some merits to a program that would mandate HIV testing.

I think the best compromise option is to offer it (not require it), counsel patients (if they are conscious and alert upon admission into the ER) as to why getting tested is of benefit to them (protect future partners, start effective treatment sooner, etc.), and offer post-test counseling if the test is positive. I truly believe “knowledge is power” and that it would be better to know than to not know about a positive HIV status.

August 17, 2009 at 4:16 pm
(8) WB says:

As a hospital lab professional, my view is that the HIV informed consent was the ONLY informed consent paperwork the lab ever received. For NO OTHER BLOOD TEST was informed consent required. Removing the requirement of informed consent is a good thing, IMHO. Above anything else, it stigmatized HIV like no other test.

The VA will require physicians notes in the chart stating the patient was informed the testing would occur and the result was communicated to the patient.

But mandatory testing is a whole ‘nother thing. Every test has false positives, and testing people who are at low risk will produce many false positives. (People who don’t have HIV but one or more screening tests suggest they might). I think providers should be able to use their clinical judgment to test people who are at moderate to high risk, while not doing blanket testing.

August 17, 2009 at 4:33 pm
(9) Haruka says:

Ok, so lemme get this straight, so everyone that walks into the ER is now doing to be tested for HIV?? This seems like a big waste of money, yes, it could be effective in saving lives, but its a waste of money for the goverment and it seems like its unconstitutional(invasion of privacy, uneccessary search and seizure, etc). So Everyone is going to get tested huh? Even a 2 yr old who gets sent to the ER for swallowing a penny, or the old guy down the street who has a heart attack is going to be tested for HIV? this is a really stupid idea America.

August 17, 2009 at 6:55 pm
(10) Trisha says:

I understand the arguments either way. But I don’t think anyone has suggested that a patient would have the opportunity to opt-out? The test would be required unless someone signed paperwork that they didn’t want it?

But nagging in my mind is the grief that is caused by a false positive….

August 21, 2009 at 7:53 pm
(11) Nicole says:

I can’t find any announcement of this on the CDC site, could you provide a link?

August 24, 2009 at 3:22 pm
(12) jo says:

I realy dont beleive tha we are close enough to an epidemic for anything to b “mandatory” these days. It would be very nice if it was offered & counseled on> but to require it with the already rising healthcare costs would be like requiring every patient to be tested for diabetes wen they came in for stitches. where does the line between good medical care & excess cost fall?

August 26, 2009 at 8:29 am
(13) judy says:

Outstanding!

August 26, 2009 at 8:43 am
(14) Pharm Salifu Monday says:

I have gone through some of the comments, but if I may ask, do the clinicians needs the patient’s consent before ordering for a BP check if he/she think is appropriate or suspect may have hypertension or did he/she needs the patient’s consent before ordering for blood sugar check if he/she suspect diabetes based on the patients history or present complain? I think seeking consents stigmatizes the HIV/AIDS test itself and the patient. Ordering for HIV/AIDS test should be left entirely in the hand of the clinician who from his judgment determine whether the patient has been at risk of being infected or may risk infecting others. Most patients decision to opt out of test are usually subjective rather than being objective and mostly from those who may have been involve in one risky behaviour or the other.

August 26, 2009 at 10:31 am
(15) Geri says:

I think it should be a mandatory part of any bloodwork regardless of what you went to the Er for. Many folks that do not know they are infected are putting their loved ones as well as others at risk. I was in the hospital when I last tested and it took that Dr.’s office 3 months to get it contact with me, (we had been at the same address and phone number for at least 6 months). I was tested Positive and in the meantime had been with a very dear friend in the meantime, thankfully he has tested negative and it has been over 2 years now since the incident. So yes, mandatory unconsentual testing needs to be done. But, On another note the ER should be equipped with a counselor who can help the poz individual understand the news he or she has been given and point them in the right direction from here.

August 26, 2009 at 2:15 pm
(16) Peggy says:

Though universal precautions are taken in the medical fields, and being a person that IS infected, I feel that testing is a good thing when blood exposure is involved or upcoming surgery that could be compromised. If a doctor found out you had cancer or any other life threating illness wouldn’t you be glad to know so that you can take appropriate care of the situation?

August 26, 2009 at 6:04 pm
(17) malik says:

well if it helps the spread of HIV then why not .
we all are living in this western world and want best for every paitent, however ER ROOMS are for emergency and if a another sample is taken well that not taking extra time but giving the patient more time to re evaluate what they may have.
ps all of you are women writing comments well here in is one from a man who has it and was also diagnosed ER

August 27, 2009 at 3:03 am
(18) Tina says:

Well, i think it might help to reduse spread of HIV. but at the same time i feel before they do a HIV test, they should consent once. becoz it would be serious matter and effect thier personal life too..

August 27, 2009 at 12:27 pm
(19) Educating Girl says:

According to Tx Dept State Health Human Services (DSHS),Only 14% of the populuation got tested for HIV last year in Texas. Which means 86% may be walking around HIV+, spreading their HIV to unsuspecting individuals. I do believe that health professionals do need to be taught on how to properly consel someone post-test, also to give resources on where to receive HIV services. Also, many people may get tested during the Window Period, b/c it can take 3-6 mnths for HIV antibodies to show up on HIV test, these individuals may actually be positive, yet walking around thinking they are negative, spreading HIV to others. Too many people opt of getting tested for HIV, even pregnant mothers can opt out of testing. I say if their testing is part of treatment, do it.

September 3, 2009 at 10:00 am
(20) DJ says:

My sister just died last month from AIDS. She had been to doctors, in out of emergency rooms and in the hospital for a year, and even had obvious symptoms, but no one gave her HIV test until she ended up in the ICU with pneumocystis. Now my sister was not someone you would think had HIV, but if maybe if they would have tested her without her consent, she would be alive today. Most people don’t think they have HIV, including myself, and I would not have a problem with the emergency room taking blood tests without my consent. I do believe, however, that everyone should at least be asked to take one if in the emergency room or if having any kind of surgery, etc.

October 31, 2009 at 2:56 pm
(21) frank says:

if you come to the er with a broken toe you should not be tested.if you come in feeling sick then you should.you should not need to consent because it is more important that the patient does not infect other people and they know they have hiv than thier privacy rights.just because they do not have risky behavior does not mean someone they had sex with didnt and so on and so on.also because they may not have symptoms for many years.hospitals should not have to report hiv to the health dept.just inform the patients they have a infectious and transmitable disease.this should not be any worse than a doctor telling you you have a brain tumor or cancer and you have two months to live.you should not need to consent because you came to the hospital to see if something is wrong with them.

November 24, 2009 at 9:42 pm
(22) Theo says:

Thats funny, cause When i was sent to the ER for being very sick i requested a HIV test because i thought it may be related and was denied. Given a load of crap story and told HIV is no longer a issue.

Of course i know better and Have pursued alternative ways to get tested but this is like the complete opposite of what the morons at the ER’s think.

If you want to make a difference educate these so called “doctors” on what HIV is so they dont spread BS lies like i was given.

December 8, 2009 at 12:52 am
(23) Liu says:

People are so selfish, they always only think about themselves – my privacy, my rights, my costs, how will it impact me – me, me, me!!!! Everyone should be more thoughtful and ALL get tested so they know their HIV status so they don’t spread it to others. If human beings were thoughtful and considerate we would not need government to make it mandatory, but unfortunately that is not the case. It is ridiculous, HIV testing is not even mandatory for child birth, common how irresponsible and selfish is that, when it can be prevented of passing HIV to your baby, if you knew your HIV status.

March 26, 2010 at 12:23 pm
(24) bobby says:

Are you pp serious. Do you know that a lot of people think that when they go to the doctor and they get blood taken they think that they are getting AIDS/ HIV testing. Ok the doctor didnt tell me I have it so I dont come on. I think it would be good. Then maybe they could only charge for the test that were postive. Or offer it for free. Maybe give the labs some type of grants to perform testing. There are people out there who know its a posiblity that they have come in contact with ppl who r infected and still dont get tested. Now what would be your comment if this article were about someone who gave others aids on purpose. None of you would be as objective as you are to mandatory testing. Be for real. This is something that is needed. Do you know how many kids are born with this because their mother werent tested and or treated. In the end when these people procreate the kids are being punshied.

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