Expanding the Availability and
Acceptance of Voluntary HIV Testing
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Expanding the Availability and Acceptance of Voluntary HIV Testing: June 2007 BACKGROUND Federal public health officials, recognizing that a significant percentage of people with HIV are not diagnosed until they present with AIDS-related illness, are recommending that the nation’s healthcare providers offer HIV testing to all individuals from the ages of 13 to 64, without regard to identified risk factors. Officials with the U.S. Centers for Disease Control and Prevention (CDC) are currently convening advisory groups to help develop national implementation guides specific to various clinical settings. In addition, the American Academy of HIV Medicine (AAHIVM) is spearheading efforts to identify medical providers’ needs in implementing the testing recommendations and to develop strategies to support those needs. People with HIV and their care providers and advocates are also working to accomplish the important goal of expanded testing and early diagnosis, but emphasizing that ethical, science-based implementation plans, attention to the continuing health needs of people with HIV, and respect for the civil and human rights of patients must be at the heart of successful efforts to increase testing. To ensure that the important stated goals of more widely-offered testing are accomplished, a coalition of people living with HIV and the legal, medical and service organizations representing them (listed below) has framed these core principles, grounded in sound medical and public health science, ethics and human rights, to be followed by public and private decision-makers as they implement expanded HIV testing services. The fundamental elements—that HIV testing must always be informed, voluntary, confidential, and supported by health care and other services, and that it is always most effective when offered by someone trusted and trustworthy—apply to all persons, including pregnant women, youth and the incarcerated, and to testing issues beyond the current discussions about implementing the new CDC recommendations. We urge all stakeholders and decision-makers to use these principles to inform their thinking and guide their activities around HIV testing expansion. In addition, we urge people living with HIV or AIDS, their medical and other care providers, their advocates, and policy makers to use these principles to measure the success of local, state, and national testing-expansion efforts.
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This set of principles comes from discussions involving a coalition of human rights, medical, HIV service, and related organizations, and is intended to guide discussions and implementation of expanded HIV testing programs. The primary authors of the principles are the AIDS Foundation of Chicago, the Center for HIV Law and Policy, and Lambda Legal, with input from advocates around the country. The principles are meant to inform stakeholders working on expanded testing. They are a tool to help stimulate conversations, planning, and community input. We hope that they will guide implementation discussions and call on stakeholders to consider treatment and care issues that should be linked to testing. They were conceived in the belief that everyone—consumers, community leaders, HIV/AIDS service organizations, physicians, nurses, public health and elected officials, etc—has a stake in achieving an expanded testing paradigm in a thoughtful and meaningful way that produces long-term benefits for those with HIV. The principles will be shared with state and federal public health officials, prevention planning groups, service and community organizations, media, and others. Endorsers of these principles are deeply concerned with the extent to which the focus on “streamlined” counseling and consent for HIV is viewed as in itself sufficient to solve the problem of late HIV diagnoses and entry into treatment. Without an equivalent focus on factors such as funding, training, and evaluation, let alone patient mistrust and the benefits of informed decision-making, relatively few will benefit and some will likely be harmed. Endorsing organizations are calling for achievable testing expansion that recognizes the importance of patient autonomy and human rights, and actually reaches the undiagnosed and affords them real access to care and services. Site Hosted By:
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