San Francisco Drops Pretest Counseling, Written Consent Requirements for HIV Testing; Verbal Consent Required

San Francisco on Tuesday became the first city in the country to require only verbal consent for public clinics and hospitals to administer HIV tests, dropping the requirements for written consent and pretest counseling in hopes of making the testing process easier, the San Francisco Chronicle reports. According to Jeffrey Klausner, director of STD prevention and control for the San Francisco Department of Public Health, pretest counseling still will be provided at the city's public clinics and hospitals for those who request it. The city last year removed funding for counseling staff at public clinics and hospitals, leaving counseling to medical workers at the facilities, Klausner said (Allday, San Francisco Chronicle, 5/18). He added that several private clinics in the city are considering similar changes to their HIV testing policies (Elias, AP/San Jose Mercury News, 5/17). The policy change follows a planned CDC proposal to revise current guidelines that require patients to sign informed-consent forms before receiving an HIV test and removing or condensing the requirements for pretest counseling (Kaiser Daily HIV/AIDS Report, 5/8).

Reasoning for Policy Change, Reaction
Klausner said San Francisco's previous policy requiring counseling and written consent -- first implemented when there was "substantial stigma" related to HIV/AIDS -- has become outdated and excessively strict. "When I reviewed testing records earlier this year, I was shocked to see a substantial proportion of people were not testing for bureaucratic reasons," Klausner said, adding, "The several layers of paperwork, the required counseling for HIV testing, they were actually a barrier" (San Francisco Chronicle, 5/18). However, Diana Bruce of the AIDS Alliance for Children Youth and Families said changing the testing system will increase the risk that people who test HIV-positive will not seek treatment. "Unfortunately, HIV follows women of color and ... poverty," Bruce said adding, "This population needs testing that is culturally competent, that builds their trust and that they have been properly informed [of] in writing." Klausner said the city "still believe[s] pretest counseling is important, but it shouldn't be mandated." Dana Van Gorder, director of state and local affairs at the San Francisco AIDS Foundation in an e-mail said, "While many counseling and consent procedures make sense to providers, they may be viewed by high-risk individuals as burdens," adding, "If that is the case, they should be carefully considered." Steven Tierney, deputy executive director of SFAF said "Anything that makes it easier to get tested is a good thing, but we believe folks have a right to full, informed consent" (AP/San Jose Mercury News, 5/17).