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September 12, 2007

Should States Require HIV Tests?

Among men who have sex with men in New York City, there has been a 33 percent increase in HIV infections over the past six years, the Department of Health announced this week. Ninety percent of the newly infected people are black and Latino. In Washington, D.C., 1 in 20 residents is HIV-positive. If the District of Columbia was a country, it would have the 11th highest HIV-infection rate in the world.

AIDS is still very much an American disease. So it makes sense that states, in accordance with recommendations from the CDC, are taking aggressive steps to curb the epidemic. New Jersey is considering requiring HIV testing for all pregnant women, unless they specifically choose to opt-out of the program. By treating the expectant mother with anti-retrovirals, cutting out breast feeding, and delivering via Cesarean, the rate of transmission between mother and child can be cut to 2 percent. And the California legislature passed a bipartisan bill tacking HIV testing onto large-scale health care reform. It would require HIV tests to be part of annual check-ups and other routine health care visits, unless a patient specifically opts out in writing. Currently, patients must give written consent to be tested, so this flips the burden. Five states already require HIV testing of pregnant women; Arkansas, Michigan, New Mexico, Texas, and Tennessee. In New York, Connecticut, and Illinois, all newborns are tested.

But there's a darker side to what seems like sensible public health efforts to weed out HIV. While required testing is supported by some HIV/AIDS advocacy groups, some feminists and civil libertarians are opposing the state measures, suggesting they pressure low-income and minority women and men, many of whom would face discrimination if their HIV-positive status was know, into undergoing the tests. Over at RH Reality Check, Emily Douglas has a good run-down of the issues at stake. Organizations such as as the ACLU are concerned that mandatory testing impedes upon patients' rights to refuse specific types of treatment for HIV or any other medical condition.

That said, it seems evident that the state has a legitimate interest in preventing the spread of a deadly, highly contagious virus from one generation to the next, as well as among the population at large. The key factor is pre-test counseling and post-diagnosis support. Since pregnant women in New Jersey would be able to opt-out of the test, they need to be given a full understanding of their rights and the health benefits of undergoing the test. And patients who test HIV-positive after a routine exam must be given support not just medically, but socially as well, to make sure they understand what resources are available should they experience discrimination.

We can't protect every HIV-positive American from a world scared of the disease and, too often, its victims. But we can educate the public. The bottom line is that it's impossible to fight a contagious disease without identifying the infected and helping them keep others safe.

--cross-posted at TAPPED


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for three years i've been talking about the crisis of HIV in women over 50--another not-talked-about problem. added to the usual reluctance to address AIDS as a major health isssue there's the discomfort with the notion of sexuality in "older" people. see the "safe sex" category on my blog.

thanks for talking about it. naomi in new york city

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