Opinion :: Guest Opinions
Keeping public health policies in line with the HIV/AIDS epidemic by Gary K. Daffin & Dr. Stephen Boswell
Bay Windows contributorsTuesday Mar 9, 2010 The Massachusetts Legislature will soon have an extraordinary opportunity to reform the way our state tests for HIV/AIDS. Legislation currently being considered by the Joint Committee on Public Health will take a number of steps to modernize the Commonwealth’s HIV testing law, which has not been updated in over two decades.
These changes, which would make HIV testing a routine part of medical care, have been anticipated. The HIV/AIDS epidemic has changed substantially since the early 1980s. With the advancement in treatment therapies, the disease is now a chronic manageable condition rather than a near-certain death sentence, particularly if diagnosed in the early stages of infection. Our state policies must be updated to reflect this fact.
One in five individuals infected with HIV -- over 5,000 in Massachusetts alone -- are unaware of their status because they have not yet been tested. This figure points to a compelling need to ensure that our laws eliminate all barriers that could discourage the testing of as many people as possible, as early as possible.
To this end, any legislation must eliminate the outdated practice of requiring patients to "Opt-In" to an HIV test by giving their written consent before a physician can conduct the test. Rather, HIV tests should be treated like the numerous other screenings to which patients agree when they give their "general consent" for medical care. Patients are informed by their doctors about the HIV test before it is administered, and have the opportunity to "Opt-Out" by declining the test. Under the "Opt-Out" approach, HIV testing becomes a routine part of a medical visit.
The Opt-Out model sends a clear message to the patient: HIV testing is routine for everyone, regardless of age, gender, race, or sexuality. This approach will reduce the stigma of the disease for both patients and providers. And under any legislative reform being considered, the existing strict confidentiality safeguards -- for both the patient and the test results -- would remain unchanged.
The Centers for Disease Control and Prevention (CDC) has recommended that states adopt routine Opt-Out testing. So have leading medical organizations, such as the American Medical Association and the American Academy of Pediatrics. Moreover, researchers from Harvard and Yale medical schools and the Massachusetts General Hospital recently concluded that a national policy of Opt-Out testing would save over 600,000 life years, through both earlier diagnoses and a decrease in the number of new infections.
By contrast, Opt-In retains the status quo testing environment which, unfortunately, is failing to reach one-fifth of the people living with HIV/AIDS. The reality is that some infected individuals do not believe that they are at risk for HIV/AIDS, some are simply too embarrassed to ask their doctor to be tested, and some mistakenly assume they are already being tested as part of their regular medical visit. In the absence of routine Opt-Out testing, these individuals unwittingly perpetuate the cycle of delayed treatment and new infections. The Opt-In approach to HIV testing hinders efforts to contain the spread of HIV, and compromises the efficacy of early detection/disease management strategies.
An Opt-Out testing framework is not a cure-all for HIV/AIDS but it is a significant step forward. The LGBT community -- and the community at-large -- must continue to take proactive actions to prevent the spread of this insidious disease. Opt-Out is an effective tool to ensure more people living with HIV know their status, is relatively simple to implement, and will undoubtedly be quick to yield real results.
Massachusetts is rightly credited with having many of the world’s leading hospitals and medical research facilities, which have made significant contributions to the advancement of cutting-edge research and to the evolution of treatments to combat HIV/AIDS. By passing legislation that adopts routine Opt-Out testing, we will modernize our HIV testing laws and bring our public health policies in line with our public health infrastructure and reputation. Ultimately, an Opt-Out approach will identify the undiagnosed earlier, connect them to care more quickly, and help save lives.
Mr. Daffin is the Executive Director of the Multicultural AIDS Coalition. Dr. Boswell is the President and CEO of the Fenway Community Health Center.
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