Chicago Sun-Times Editorial - Compromise needed to boost HIV testing/HIVtest bill raises fears - Patient's consent would be waived to widen screenings
Chicago Sun-Times Editorial - Compromise needed to boost HIV testing
Copyright by The Chicago Sun-Times
May 3, 2007
Nearly everyone agrees more voluntary HIV testing is a good thing -- a critically needed thing. People who don't know they are HIV-positive -- and according to the AIDS Foundation of Chicago, 10,000 Illinoisans are in the dark, 8,000 of them in the city, at least two-thirds of them people of color -- are putting themselves and those with whom they have relations at serious risk. Individuals who test positive, knowing of their condition, have a much better chance of surviving it through treatment and counseling.
Making HIV testing a routine part of people's health care, as the Centers for Disease Control is determined to do -- with patients' knowledge and with patients having the right to not be tested -- seems to be a good way to expand these screenings. But the CDC's push to eliminate the requirement of written consent for the tests, as well as pre-test counseling, has the potential to do more harm than good. So, then, does a bill before the Illinois House that in its current form endorses those CDC guidelines.
HIV is anything but a routine disease. Unlike cancer or heart disease, it carries a powerful stigma, particularly in certain low-income communities, where a large percentage of people -- black males especially -- resist testing. Dire consequences can come from administering an HIV test to individuals who don't know they don't have to take it, aren't educated about the infection and ways to fight it, and don't yet have a support group to help get them through. Doctors and AIDS activists see the written consent as essential to the cause of protecting HIV patients' basic rights.
In New York, public hospitals have shown it's possible to greatly increase HIV testing by incorporating it into routine medical care -- without eliminating the requirement of informed, written consent. By going with a rapid testing program, streamlining and diversifying counseling and making testing available in emergency departments, outpatient clinics and other facilities away from the usual spots, New York increased the number of those tested in 2006 by a whopping 63 percent over 2005 and doubled the number of HIV-positive patients identified.
Proponents of the Illinois bill, sponsored by Rep. LaShawn Ford (D-Chicago), have said they're flexible on the matter of signed consent and counseling. It remains to be seen, though, if federal funds targeted for HIV testing are tied to the strict adoption of the CDC's guidelines. Illinois Reps. Bobby Rush, Danny Davis and Jan Schakowsky have written a letter asking for clarification. Clearly, the best medicine here would be a compromise by the CDC that preserves a system proven to work well.
HIV-test bill raises fears - Patient's consent would be waived to widen screenings
By Jeremy Manier
Copyright © 2007, Chicago Tribune
Published May 1, 2007
Doctors in Illinois may no longer have to get written consent from patients to give them HIV tests under a controversial state bill that's part of a national effort to make HIV testing more routine.
Supporters of the bill, which could come to a vote in the Illinois House this week, say it would give crucial knowledge to the estimated 10,000 Illinois residents who are infected with the virus that causes AIDS but don't know it. The initiative would enact new testing guidelines that the federal Centers for Disease Control and Prevention published last year in hopes of screening all patients between ages 13 and 64.
But the change in law also would require rescinding parts of Illinois' 20-year-old AIDS Confidentiality Act, which ensures that patients cannot get tested for HIV without their knowledge.
Tensions between patients' rights and public health priorities have made the bill a politically dicey subject.
After advocates from the AIDS Foundation of Chicago and the AIDS Legal Council of Chicago announced their opposition to the bill on Monday, officials with the Illinois Department of Public Health said they would try to modify the legislation. The officials said they would work with Rep. LaShawn Ford (D-Chicago), the bill's sponsor, to add language clarifying the need for counseling and verbal consent before patients get tested for HIV.
All medical procedures require some form of consent, but doctors do not have to get specific, written permission to do routine tests. Officials with the Centers for Disease Control said the new guidelines would make HIV testing a normal part of medical care, requiring no patient action beyond the general consent forms that patients sign at the start of most visits.
"You don't have to obtain written informed consent for any other blood test," said Dr. Bernard Branson, who helped write the center's HIV testing guidelines.
"When a procedure requires more risk, that's usually when you have to get something separate in writing," Branson said.
Removing that bureaucratic hurdle could expand the number of people getting tested. A study published last month in the Journal of the American Medical Association found that when San Francisco's public health system ended its requirement for written consent in 2006, more patients were tested and more of them tested positive for HIV.
Center officials said a change to Illinois' consent rules may be necessary if the state is to receive its share of $30 million in new federal money to support early HIV diagnosis programs.
The Illinois law requiring written consent is a product of the 1980s, when the stigma surrounding AIDS was at its peak. Some activists believe that stigma is still strong enough to justify special procedures for tests that could reveal an HIV infection.
"If we don't test the right way, individuals could really be alienated from the health care system," said John Peller, director of state affairs for the AIDS Foundation of Chicago. "For many people, there's still a tremendous, deep stigma about testing positive for HIV. What we really need to do is help individuals come to the decision on their own that they should get tested."
Ann Fisher, executive director of the AIDS Legal Council of Chicago, said routine tests could result in patients getting screened for HIV without being told about it.
Yet the Centers for Disease Control guidelines on which the proposed bill is based specifically address that point. The guidelines state, "Patients must not be tested without their knowledge." The guidelines would create an "opt-out" system in which patients are told they will receive a test but can choose not to get tested.
All opponents of the proposed law said they share the center's goal of expanding testing and helping more people find out if they are HIV-positive. But they want to make sure counseling is offered before and after the tests to help patients deal with the results and get appropriate care.
"Written consent is a way of proving you've had that discussion," Fisher said.
For the bill's supporters, getting patients tested and treated is the only issue.
"What's wrong with being educated on your health?" said Rep. Mary Flowers (D-Chicago), a bill co-sponsor. "We can live with HIV now as opposed to dying from it. But you have to know you have it, and the only way to do that is to get tested."
The political problems the bill raised made it difficult to gauge the position of the Illinois Department of Public Health
Ford, the bill's sponsor, said the Health Department actually drafted the language that would remove the need for written consent. Yet on Monday, after several AIDS groups announced opposition, department spokeswoman Melaney Arnold said her agency was taking a neutral position on the bill.
But later in the day, Arnold switched gears again and said the department would work on changing language in the bill, in hopes of producing something it could support.
"We had some other constituents bring some concerns to light," said Arnold.
jmanier@tribune.com
Copyright by The Chicago Sun-Times
May 3, 2007
Nearly everyone agrees more voluntary HIV testing is a good thing -- a critically needed thing. People who don't know they are HIV-positive -- and according to the AIDS Foundation of Chicago, 10,000 Illinoisans are in the dark, 8,000 of them in the city, at least two-thirds of them people of color -- are putting themselves and those with whom they have relations at serious risk. Individuals who test positive, knowing of their condition, have a much better chance of surviving it through treatment and counseling.
Making HIV testing a routine part of people's health care, as the Centers for Disease Control is determined to do -- with patients' knowledge and with patients having the right to not be tested -- seems to be a good way to expand these screenings. But the CDC's push to eliminate the requirement of written consent for the tests, as well as pre-test counseling, has the potential to do more harm than good. So, then, does a bill before the Illinois House that in its current form endorses those CDC guidelines.
HIV is anything but a routine disease. Unlike cancer or heart disease, it carries a powerful stigma, particularly in certain low-income communities, where a large percentage of people -- black males especially -- resist testing. Dire consequences can come from administering an HIV test to individuals who don't know they don't have to take it, aren't educated about the infection and ways to fight it, and don't yet have a support group to help get them through. Doctors and AIDS activists see the written consent as essential to the cause of protecting HIV patients' basic rights.
In New York, public hospitals have shown it's possible to greatly increase HIV testing by incorporating it into routine medical care -- without eliminating the requirement of informed, written consent. By going with a rapid testing program, streamlining and diversifying counseling and making testing available in emergency departments, outpatient clinics and other facilities away from the usual spots, New York increased the number of those tested in 2006 by a whopping 63 percent over 2005 and doubled the number of HIV-positive patients identified.
Proponents of the Illinois bill, sponsored by Rep. LaShawn Ford (D-Chicago), have said they're flexible on the matter of signed consent and counseling. It remains to be seen, though, if federal funds targeted for HIV testing are tied to the strict adoption of the CDC's guidelines. Illinois Reps. Bobby Rush, Danny Davis and Jan Schakowsky have written a letter asking for clarification. Clearly, the best medicine here would be a compromise by the CDC that preserves a system proven to work well.
HIV-test bill raises fears - Patient's consent would be waived to widen screenings
By Jeremy Manier
Copyright © 2007, Chicago Tribune
Published May 1, 2007
Doctors in Illinois may no longer have to get written consent from patients to give them HIV tests under a controversial state bill that's part of a national effort to make HIV testing more routine.
Supporters of the bill, which could come to a vote in the Illinois House this week, say it would give crucial knowledge to the estimated 10,000 Illinois residents who are infected with the virus that causes AIDS but don't know it. The initiative would enact new testing guidelines that the federal Centers for Disease Control and Prevention published last year in hopes of screening all patients between ages 13 and 64.
But the change in law also would require rescinding parts of Illinois' 20-year-old AIDS Confidentiality Act, which ensures that patients cannot get tested for HIV without their knowledge.
Tensions between patients' rights and public health priorities have made the bill a politically dicey subject.
After advocates from the AIDS Foundation of Chicago and the AIDS Legal Council of Chicago announced their opposition to the bill on Monday, officials with the Illinois Department of Public Health said they would try to modify the legislation. The officials said they would work with Rep. LaShawn Ford (D-Chicago), the bill's sponsor, to add language clarifying the need for counseling and verbal consent before patients get tested for HIV.
All medical procedures require some form of consent, but doctors do not have to get specific, written permission to do routine tests. Officials with the Centers for Disease Control said the new guidelines would make HIV testing a normal part of medical care, requiring no patient action beyond the general consent forms that patients sign at the start of most visits.
"You don't have to obtain written informed consent for any other blood test," said Dr. Bernard Branson, who helped write the center's HIV testing guidelines.
"When a procedure requires more risk, that's usually when you have to get something separate in writing," Branson said.
Removing that bureaucratic hurdle could expand the number of people getting tested. A study published last month in the Journal of the American Medical Association found that when San Francisco's public health system ended its requirement for written consent in 2006, more patients were tested and more of them tested positive for HIV.
Center officials said a change to Illinois' consent rules may be necessary if the state is to receive its share of $30 million in new federal money to support early HIV diagnosis programs.
The Illinois law requiring written consent is a product of the 1980s, when the stigma surrounding AIDS was at its peak. Some activists believe that stigma is still strong enough to justify special procedures for tests that could reveal an HIV infection.
"If we don't test the right way, individuals could really be alienated from the health care system," said John Peller, director of state affairs for the AIDS Foundation of Chicago. "For many people, there's still a tremendous, deep stigma about testing positive for HIV. What we really need to do is help individuals come to the decision on their own that they should get tested."
Ann Fisher, executive director of the AIDS Legal Council of Chicago, said routine tests could result in patients getting screened for HIV without being told about it.
Yet the Centers for Disease Control guidelines on which the proposed bill is based specifically address that point. The guidelines state, "Patients must not be tested without their knowledge." The guidelines would create an "opt-out" system in which patients are told they will receive a test but can choose not to get tested.
All opponents of the proposed law said they share the center's goal of expanding testing and helping more people find out if they are HIV-positive. But they want to make sure counseling is offered before and after the tests to help patients deal with the results and get appropriate care.
"Written consent is a way of proving you've had that discussion," Fisher said.
For the bill's supporters, getting patients tested and treated is the only issue.
"What's wrong with being educated on your health?" said Rep. Mary Flowers (D-Chicago), a bill co-sponsor. "We can live with HIV now as opposed to dying from it. But you have to know you have it, and the only way to do that is to get tested."
The political problems the bill raised made it difficult to gauge the position of the Illinois Department of Public Health
Ford, the bill's sponsor, said the Health Department actually drafted the language that would remove the need for written consent. Yet on Monday, after several AIDS groups announced opposition, department spokeswoman Melaney Arnold said her agency was taking a neutral position on the bill.
But later in the day, Arnold switched gears again and said the department would work on changing language in the bill, in hopes of producing something it could support.
"We had some other constituents bring some concerns to light," said Arnold.
jmanier@tribune.com
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