A bill recently passed by the Massachusetts Senate and awaiting approval in the House would take steps at bringing HIV testing policy in Massachusetts into the 21st century. Currently, Massachusetts is one of only two states that have not adopted the 2006 recommendations for HIV testing released by the Centers for Disease Control and Prevention (CDC).
Testing Policy in Massachusetts
Testing for HIV is regulated by a law written in 1986 and requires separate written informed consent to perform an HIV test. However, this policy is viewed by many as a barrier to testing and results in fewer HIV tests. Connected to the lack of testing, health experts in the state estimate that 20 percent of those infected with HIV are unaware of their infection status.
The primary goal of Bill S2158 is to eliminate the need for written consent and instead ask for a verbal consent. This policy paves the way for opt-out screening, as endorsed by the CDC. A physician notifies the patient that an HIV test will be performed and that the patient may decline, or “opt-out.” Unless the patient specifically refuses, the test will be administered. The bill maintains the requirement for written consent to share information about testing or results with other healthcare providers.
Increased Testing vs. Privacy Concerns
Opt-out screening and reduced regulation around HIV testing has been championed by many physicians, public health professionals, and HIV/AIDS organizations. The benefits of such a policy are many: HIV testing becomes more normalized in healthcare, more patients are screened, and more HIV positive patients are identified and can receive life-saving care.
The main concerns of opponents revolve around issues of privacy and confidentiality. Because stigma and discrimination towards those with HIV/AIDS remains present, some AIDS advocates are worried about maintaining privacy around testing and results.
Conversely, many voices from the medical field critique that the bill does not go far enough in updating HIV testing policy. The current wording on the bill means the fact that an HIV test was ordered cannot be entered in a medical record that can be viewed by other healthcare professionals. The Massachusetts Medical Society released a statement that this policy will interfere with sound medical care. It also questioned how these regulations could be applied to electronic medical records, an emerging technology. The MMS calls for legislators to treat HIV like any other disease, subject to the same privacy laws.
Routine Testing Saves Lives
There are many good reasons to integrate HIV testing into routine healthcare. Early initiation of treatment, with its improved outcomes and reduced transmission, provides the strongest support for routine testing.
For people living with HIV, current drug regimens can transform it into a manageable chronic condition. Highly active antiretroviral therapy (HAART) adds years of healthy life, especially when treatment is begun before the disease progresses to AIDS. But to start treatment early, a patient must know they are infected. More opportunities to receive an HIV test increase the number of patients identified and receiving care.
Improved quality and length of life are not the only benefits of early treatment. Treatment lowers the amount of virus present in the bloodstream, which makes the virus less transmissible to others. Furthermore, studies suggest that people are likely to adopt behaviors to protect others, such as increased condom use, after learning they are HIV positive.
Concerns about privacy are unpersuasive because HIV tests, results, and treatment records are medical information. They are protected under the HIPAA privacy rule, which strictly prohibits release of medical records without patient consent. The original legislation was created when people living with HIV were subject to real discrimination. However, HIV/AIDS is now included as a protected class in the Americans with Disabilities Act. No one may be denied housing, employment, government services, etc. due to their HIV status. These developments make it “totally unnecessary” to require a second consent from patients with HIV, as argued in activist Ed Perlmutter’s blog.
Conclusion: It’s Time for Change
HIV/AIDS is certainly not a simple disease; it has a complicated social history. Current legislation rightly reflects that history. But times have changed and Massachusetts laws need to change too. It’s time to start treating people living with HIV/AIDS like those living with any other disease.