Massachusetts Resists Implementing CDC Recommendation To Waive Written Consent Requirement for HIV Tests, Boston Globe Reports
Massachusetts is "resisting a year-old push by federal health authorities" to implement CDC's recommendations to waive a written consent requirement for HIV tests and make the tests a routine part of medical care for people ages 13 to 64, the Boston Globe reports. According to the Globe, Massachusetts is one of 10 states that require written consent for HIV tests.
Health officials in Massachusetts say they share CDC's goal of making HIV testing more routine. Officials also say that they believe they can increase testing rates and still require written consent by conducting an additional 11,300 tests in health and family planning clinics and substance abuse treatment facilities over the next two years. Under the Ryan White Program reauthorization, the state could receive less federal funds if new HIV cases are diagnosed more slowly than in states that implement CDC's guidelines, although the amount is unclear. Massachusetts currently receives $19.5 million annually under the program, the Globe reports. About 12 states have passed laws in an effort to implement the CDC guidelines, according to the Globe.
According to some state officials and HIV/AIDS advocates, stigma associated with HIV is still widespread, and written consent and pretest counseling should continue to be required. Massachusetts Public Health Commissioner John Auerbach said many health officials are concerned that people at high risk for HIV will avoid medical care if an HIV test could be conducted without their consent. Auerbach added that he might consider changing his position if waiving the written consent requirement would save the state money.
The debate over written consent for HIV tests has "exposed a deeper divide" about whether HIV/AIDS should "continue to be regarded as something exceptional, with policies, resources and attention distinct from other conditions," the Globe reports. B. Dale Magee, president of the Massachusetts Medical Society, said the society "want[s] the state to treat HIV like other communicable diseases." Magee added that written consent is not required for tests for tuberculosis, gonorrhea or syphilis.
The CDC guidelines state that testing should be voluntary and that patients should be told they are receiving an HIV test. According to Ben Klein, director of the AIDS Law Project at Gay & Lesbian Advocates & Defenders, the guidelines do not address the realities of medical care. "For doctors who are overworked and in busy health care settings ... there's going to barely be a discussion," he said, adding, "What has been really important about written consent is it's really not about the testing process alone. It's the beginning of a process and a relationship between the doctor and the patient that goes beyond testing" (Smith, Boston Globe, 9/1).