Too broad a brush

September 27, 2006

Aproposal for administering an HIV-AIDS test to every patient who encounters the health care system - from pubescent teens to recent retirees - has an appealing simplicity.

No fuss about risk analysis; no muss about stigma. Just a routine matter conducted at the time of other blood work that could give tens of thousands of Americans vital health information before symptoms emerge, possibly saving their lives and the health of those whom they might otherwise infect.

Yet universal HIV-AIDS testing as recommended last week by the Centers for Disease Control and Prevention has drawbacks as well, including price and privacy considerations, that deserve thoughtful debate, community by community, before the policy is adopted

In Maryland, for example, testing all Baltimore residents ages 13 to 64 on a voluntary basis makes a great deal of sense. The city is home to nearly 50 percent of the state's HIV and AIDS cases, but only 12 percent of the population. A 3-month-old experiment of such widespread testing in Washington has revealed an infection rate twice the national average.

The efficacy of automatically offering HIV-AIDS tests to teens and adults on the Eastern Shore and Western Maryland is less clear.

A preliminary AIDS test that comes back negative costs about $8. But a positive result requires a more extensive battery of tests that range up to $80. That's not much compared with the exorbitant cost of AIDS treatment, but a potential burden nonetheless on a health care system that leaves many Americans without any coverage at all.

Further, in order to implement the CDC testing recommendations, Maryland's General Assembly would have to remove the current requirement that an HIV-AIDS test cannot be administered without written consent of the patient.

Physicians at Johns Hopkins Hospital, which began a policy early this year of testing all emergency room patients for HIV, complain that the paperwork requirements are too cumbersome for an ER's hectic pace.

Acquiring consent for an HIV-AIDS test - though not formally with a signed document, as Maryland requires - remains a part of the CDC recommendations because it has a valuable purpose. Some of the stigma may have diminished, but enough remains that patients should be prepared to deal with the consequences of the test. The names of patients who test positive for AIDS are reported to a state data bank.

An even more important matter to be worked out in advance is ensuring that a patient who tests positive for HIV or AIDS will have access to treatment.

Widespread routine HIV-AIDS testing may well help reduce the stubbornly static infection rate, and even the stigma. But given the finite limits of health care resources, so broad an approach makes little sense.

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