HIV Screening in Health Care Settings: Public Health and Civil Liberties in Conflict?

Abstract:     
On September 22nd, 2006, the Centers for Disease Control and Prevention (CDC) issued a sweeping revision of its guidelines for HIV screening in health care settings that reversed decades of habitual thinking on AIDS policy. Previous guidelines recommended HIV testing only for persons at high-risk or in health care settings with high HIV prevalence. This reflected a civil liberties approach that constrained testing with costly, cumbersome procedures for pre-test counseling and written informed consent. The new guidelines represent a radical departure by recommending HIV screening for all individuals ages 13 to 64 as a part of routine medical care irrespective of lifestyle, perceived risk, or HIV prevalence. The recommendations incorporate a concept known as "opt-out" testing, which notifies all patients that testing will be performed unless an individual specifically declines. Separate written informed consent would no longer be required, but rather general consent for medical care would be sufficient. Similarly, counseling would not be required with HIV diagnostic testing or as part of HIV screening programs.

This commentary examines the social and historical context of HIV screening, the changing epidemiology of HIV/AIDS, legislative and liability barriers to implementing CDC guidelines, and enduring conflicts between public health and civil liberties approaches to HIV/AIDS. The commentary concludes that the new CDC guidelines will facilitate prevention and treatment, but must overcome cultural and legal obstacles for success.

Keywords: HIV, health care, civil liberties

Accepted Paper Series