Should patients be informed they're getting HIV test?

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BY NANCY HICKS / Lincoln Journal Star

When Nebraskans go to the doctor for a routine physical, they generally have blood work done — testing for diabetes, thyroid disease, liver and kidney disease, cholesterol.

They sign a form giving permission for these tests, not knowing what specifically tests will be run.

At least part of Nebraska’s health establishment wants to make testing for HIV a part of that routine, eliminating the special permission now required to do it.

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The AIDS stigma has lessened, and there are enormous benefits in treating for the AIDS virus long before serious symptoms appear, said supporters of an HIV testing bill.

The measure (LB954) would eliminate the state’s requirement that patients be told they will be tested for HIV. Supporters include the Nebraska Hospital Association and the Nebraska Medical Association.

But opponents of the measure say AIDS is not viewed the same as, say, high cholesterol, and fear and stigma remain. Patients still need more detailed information and counseling and the chance to refuse or opt out of the HIV test, opponents said in letters and in personal testimony during a hearing last week before the Legislature’s Health and Human Services Committee.

“People are more comfortable discussing this issue, and testing is not taboo any longer,” said Sen. Cap Dierks of Ewing, sponsor of the bill.

AIDS is no long a death sentence, it is evolving into a chronic disease, said Rita White, representing the Nebraska Hospital Association. Testing is no longer just a diagnostic tool, but a screening device, sometimes with enormous benefits, she said.

In a 1995 study, treatment for pregnant women who were HIV positive greatly reduced the number of babies born with the virus.  The transmission rate went from 50 percent to 60 percent to 8 percent, White pointed out.

Those who believe HIV testing should require special consent also used an example involving pregnant women.

Three women who tested positive during pregnancy and refused treatment were turned over to child protective services, said Sharon Renter, executive director of the Nebraska AIDS Project. All three fled the state, she said.

Renter believes more women may run away from medical care if physicians don’t provide appropriate information and referral.

“I’m a strong supporter of normalizing AIDS and reducing the stigma,” Renter said.

But, she said, patients still need to be informed before the testing and have an opt-out provision.

Testing can carry unintended consequences, she said, such as life insurance companies looking to see if a person has ever been tested.

In fact, the bill goes beyond what the Centers for Disease Control and Prevention is recommending, according to several people who wrote letters to the committee.

Current state law requires people consent to the test. The bill would remove any notification that the test would be given.

CDC recommends HIV testing become a routine part of the care of pregnant women and patients at risk. But it also recommends that patients be notified an HIV test may be performed, with an opportunity to opt out, wrote Dr. Joann Schaefer, Nebraska’s chief medical officer.

“The original intent of Nebraska statute was to protect the confidentiality and rights of individuals seeking medical care and treatment,” she wrote. “The CDC recommendations do not seek to remove these protections but rather to make it easier for service providers to make HIV testing available.”

Reach Nancy Hicks at 743-7250 or nhicks@journalstar.com.