amfAR, The Foundation for AIDS Research

CDC’s 2006 Routine HIV Testing Guidelines Incompatible with State Laws

Nov. 6, 2007–In October 2007, the Public Library of Science (PLoS) published an article[1] entitled “Implementing Routine HIV Testing: The Role of State Law.” The study came in response to the release of updated guidelines for routine HIV testing by the Centers for Disease Control and Prevention (CDC) in September 2006[2]. The authors found that more than 30 states will be unable to implement these guidelines because of state laws requiring counseling and informed consent for HIV testing that differ from CDC recommendations.

The objective of the revised CDC recommendations is to make HIV testing a routine component of health care. The CDC supports voluntary “opt-out” HIV screening in health-care settings for all Americans aged 13–64, eliminating the requirement for pre-test counseling and written informed consent. This approach conflicts with state requirements on consent and counseling. Currently, 33 states require either written or oral informed consent for HIV testing and 24 states require disclosure of specific information (i.e., the nature of the HIV test, HIV risk behaviors, and prevention measures) during either pre-test counseling or the informed consent process.

Although the CDC’s new testing guidelines may significantly increase the number of individuals aware of their HIV status, they cannot be imposed on states. State legislatures will have to amend their laws if they want to permit the implementation of the guidelines. A number of states (such as Rhode Island and Illinois) have taken action to comply with the CDC’s recommendations and legislative changes are slowly being implemented in other states.

Despite a general consensus about the need for individuals to know their HIV status, many advocates are concerned about the implementation of these guidelines given the continuing stigma associated with HIV in the U.S. Advocates are also concerned about patient confidentiality, insurance coverage of medical testing, and access to treatment for those found to be HIV positive. Additionally, some researchers and advocates believe that although routine testing will increase the number of people who know their HIV status, testing alone is insufficient to reduce the spread of HIV/AIDS. They feel that the CDC’s initiative needs to be coupled with more intensive, targeted prevention campaigns focusing on the communities most affected by HIV/AIDS.

For additional information on HIV testing, see amfAR’s Policy Statement on Routine HIV Testing.

For additional information about the CDC Guidelines and state laws regarding HIV testing, see:

[1] Implementing Routine HIV Testing: The Role of State Law 

[2] Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings