Monday, June 26, 2006

Women's Bioethics Blog

Routine HIV testing in the District of Columbia

I have often wondered if blood samples taken for laboratory tests or during hospitalization are screened for human immunodeficiency virus (HIV). One could argue that routine screening of blood samples would be a good laboratory safety precaution; or that it could help catch infections in unsuspecting individuals, allowing early treatment and slowing the spread of the disease overall. A battery of questions flows: Could it also be argued that routine lab and hospital screening is too costly to be practical? Are there a set of guidelines for when HIV screening is performed? Are HIV screenings only performed when they must be ruled out as part of an explanation for a set of symptoms? Was my blood screened for HIV when I was hospitalized? Would I have been told only if my test was positive? Would routine hospital screening for HIV be considered a violation of privacy or other rights without patient consent?

Now the city of Washington, DC, which is believed to have the highest rate of HIV infection in the country (179.2/100,000 people), is urging mandatory HIV testing as part of routine health screening for all patients between the ages of 14 and 84. The Centers for Disease Control (CDC) has been pushing for physicians to routinely screen patients, but this is the first local effort of its kind. Starting tomorrow, the city will distribute 80,000 tests to community groups, doctors' offices, emergency rooms, and STD clinics. These are oral swab tests that produce results in twenty minutes, as opposed to blood tests that can take two weeks to process. According to Jason DeParle of the New York Times, this is "significant because many people who underwent the earlier tests never returned to learn the results, meaning those with the virus remained unaware of the risk they posed to others." I would take a guess that any test that can be processed in twenty minutes is also much less costly than one that gets sent to the lab for two weeks.

While the practicality of an oral test and the idea of routine testing potentially dissolve a few barriers toward HIV detection, there are still many questions to be addressed. Firstly, in a city of more than 550,000, how far will 80,000 tests go, and what happens when they run out? Susan Levine of the Washington Post reported on Saturday that the aim is to use up that supply by the end of the year, "which would mean reaching a fifth of their key population in the next six months." Both Patricia Nalls of the Women's Collective in Northwest Washington and Walter Smith of the DC Appleseed Center for Law and Justice expressed concerns about not having heard any detail about planning for necessary counseling and follow-up care for a newly diagnosed HIV-positive population.

It is also unclear as to whether routine screening does present a privacy issue. Alan Cross reported that the "recommendation met with some resistance from privacy advocates who felt that such a testing might end up stripping HIV-positive people of their privacy and a breach of confidentiality would make it difficult for them to lead normal lives."

Sources and further reading:

Deparle, Jason, "District of Columbia Urges Routine HIV Testing." New York Times, 25 June 2006,

Levine, Susan, "DC Wants HIV Testing for All Residents 14 to 84." Washington Post, 24 June 2006, A01,

Cross, Alan, "DE's new campaign to test 14 to 84 year-olds for HIV.", 25 June 2006,

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