March 8, 2007
Dispelling Myths: Consent for Testing
What the CDC Says:
- HIV testing must be voluntary.
- Patients must know that testing is planned and be informed that they will be tested unless they decline (“opt out”).
- The patient should be provided information about HIV infection and the meanings of positive and negative test results and be provided an opportunity to ask questions and decline testing.
- General informed consent for medical care is sufficient to encompass informed consent for HIV testing.
What the CDC Does Not Say:
- CDC does not state that people can
be tested without their knowledge or without
providing informed consent. Informed
consent for medical treatment is required by
law and by medical ethics.
- Given the CDC’s acknowledgment
that testing must be voluntary and informed,
its reference to “general informed consent for
medical care” appears to relate solely to its
view of how consent must be documented.
- Many advocates and others question
whether testing under an “opt out” program
will be fully voluntary. The CDC has not
answered this question.
Dispelling Myths: Counseling Prior to Testing
What the CDC Says:
- CDC recommends that “prevention
counseling” not be required prior to testing.
It defines “HIV-prevention counseling” as
involving individual risk assessment and
development of a plan to reduce those risks.
- CDC acknowledges that obtaining
informed consent for HIV testing involves
providing information about HIV, the risks
and benefits of testing, the implications of test
results, how test results will be
communicated, and the opportunity to ask
questions.
What the CDC Does Not Say:
- CDC is not recommending that there
be no counseling prior to testing. It
recommends only that a very specific form of
counseling -- focused on individualized risk
assessment and reduction -- not be provided.
- CDC is not saying that all state
counseling requirements conflict with its
recommendations. In fact, some state laws
require that pre-test counseling provide the
same pretest information that CDC
recommends (an explanation of HIV
infection and the meanings of positive and
negative test results).
Dispelling Myths: The Status of the Recommendations
What the CDC Says:
- CDC clearly labels these as
“recommendations,” not “requirements.”
- CDC acknowledges that some states,
local jurisdictions, or agencies have legal
requirements related to consent or counseling
that conflict with some of the
recommendations and that those
recommendations cannot be implemented
unless such conflicts are resolved.
- These recommendations do not
modify existing guidelines for HIV testing in
non-clinical settings (e.g., community-based
organizations, outreach settings).
What the CDC Does Not Say:
- CDC does not say that these
recommendations must be followed.
- CDC does not say that its
recommendations are the only means of
increasing testing. In fact, it references
studies in which increased, non-risk based,
testing was achieved without abandoning
specific written consent and/or pre-test
counseling.
