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September 21, 2006
CDC GUTS CONSENT & COUNSELING
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Controversies over testing policies drews disruption at the International AIDS Conference in Toronto last month. Dr. Anthony Fauci, Director of the National Institutes for Allergy and Infectious Disease (NIAID), was called to exercise his influence with President Bush and call for a comprehensive prevention agenda. |
On Thursday, September 21, the Centers for Disease Control and Prevention (CDC) published new recommendations designed to make voluntary HIV screening a routine part of medical care for all patients ages 13 to 64. The new guidelines eliminate the government's prior recommendations for pre-test counseling and informed, written consent prior to HIV testing.
Front-line HIV prevention and testing workers are alarmed at the government's actions, and called for universal voluntary HIV testing with informed consent. Sixteen groups, including Housing Works, signed on to a rapid-response statement that said the CDC's "expanded focus on testing without counseling and written, informed consent will put people at risk for testing without their prior knowledge or approval- a clear violation of medical ethics and human rights."
The statement also criticized the CDC for de-linking HIV testing from HIV education, counseling and prevention.
All players agree that the U.S. needs more HIV testing, particularly in the communities hardest-hit by HIV/AIDS. The problem is that universal voluntary testing with simple written consent has never been tried in the U.S. Critics of the current structure of HIV testing have overwhelmingly focused on written consent as a supposed barrier to testing, failing in most cases to note that voluntary HIV tests are never offered on a universal basis at potential high-yield settings like homeless shelters, jails, welfare centers, public hospitals and chemical dependency treatment centers.
CDC officials Dr. Kevin Fenton (Director, National Center for HIV, STD, and TB Prevention), Dr. Timothy Mastro, M.D. (Acting Director, Division of HIV/AIDS Prevention), and Dr. Bernard Branson, M.D. (Associate Director for Laboratory Diagnostics) faced AIDS groups on a conference call announcing the new guidelines Thursday and said healthcare settings present "missed opportunities" for testing and that making testing routine is "normalizing" and may help reduce HIV stigma.
When asked about why the CDC moved away from recommending written consent and adopted an opt-out model, a representative of the CDC explained that it was an "evolution in thinking." He added that they had been "subject to some lobbying by private providers that this has created a significant barrier for them and their families." The CDC recommendations suggest that a general consent for health care and treatment are sufficient to cover HIV tests.
"Right now we're concerned that CDC is promoting testing as a magic bullet for both HIV prevention and better health outcomes as a result of earlier diagnosis," said Sean Barry, Director of Prevention Policy for CHAMP- the Community HIV/AIDS Mobilization Project.
"Expanded testing, if done right, is a key part of achieving both of those goals. But the emphasis on testing at CDC has come at the same time federal funds for HIV prevention have been cut (although a paltry sum of new proposed funding is may be approved for next year) and at the same time Congress refuses to authorize enough funding for Ryan White programs," Barry said. "Now that the guidelines are out, key challenges will include shaping the implementation guidance for each setting they apply to and closely monitor how CDC encourages state legislatures to open up their laws on current testing practices."
It's likely that the CDC will face continued protest - and perhaps a lawsuit - over the recommendations. The Health Privacy Project quickly noted Thursday that the American Bar Association outlined the legal case against allowing HIV testing without separate, written informed consent in a letter to the CDC last month (link to letter PDF). The ABA noted that a general consent can cover only those procedures for which the risks and benefits are generally known; "the risks and benefits of an HIV test, by contrast, involve complex physical, emotional, social and legal consequences, and thus cannot be encompassed by a general medical consent." Enough for a fast, hard lawsuit? We'll keep you posted.
GETTING MORE OUT OF TESTING
We know we don't want to live in the reality of the CDC vision for testing so we need to explain what ethical testing in the midst of this crisis would look like. Read the latest on this and more testing issues in the latest HHS Watch newsletter by CHAMP, the Community HIV/AIDS Mobilization Project.
WHO'S ALREADY ON BOARD FOR ETHICAL TESTING?
The organizations listed below joined the rapid-response statement to CDC officials that calls for recommendations that reflect the reality of the AIDS crisis.
ACT UP Philadelphia
African American Health Alliance (AAHA)
AIDS Alliance for Children, Youth and Families
AIDS Foundation of Chicago
AIDS Network, Madison, WI
AIDS Survival Project
American Medical Student Association (AMSA)
amFAR, The Foundation for AIDS Research
Brothers Uplifting Brothers, Inc., Merrillville, IN
Community HIV/AIDS Mobilization Project (CHAMP)
East Bay AIDS Advocacy Foundation
Ebony Sisters Campaigning for AIDS Prevention Education (ESCAPE)
Gay Men’s Health Crisis (GMHC)
Harm Reduction Coalition
Heartland Health Outreach
HIV Law Project
Housing Works
Lambda Legal
Minnesota AIDS Project
New York State Black Gay Network
Ohio AIDS Coalition
Pediatric AIDS Chicago Prevention Initiative
Project Inform
Sexuality Information and Education Council of the United States (SIECUS)
The AIDS Institute (TAI)