CITY HEALTH AGENCIES MOVE TO STREAMLINE HIV TESTING

San Francisco Drops Counseling Requirement

San Francisco's public medical clinics and hospitals will no longer
require written consent and counseling sessions before HIV tests, and
public health officials say they hope the easier, less time-consuming
process will prompt more people to get tested.

The shift in policy, which took effect Tuesday, follows a similar
proposal from the Centers for Disease Control in March, as the health
care industry grapples with estimates that more than 20 percent of
those infected with HIV don't know it -- and continue to spread the disease.

San Francisco is the first city in the country to adopt the new
policy, under which people will have to give verbal, not written,
permission for testing. Pretesting counseling will still be offered
to those who want it, but it will no longer be mandatory, said Dr.
Jeffrey Klausner, director of STD Prevention and Control for the San
Francisco Department of Public Health.

Last year, 20,000 people were tested for HIV in San Francisco, and
440 of them tested positive, Klausner said.

"When I reviewed testing records earlier this year I was shocked to
see a substantial proportion of people were not testing for
bureaucratic reasons," Klausner said. "In medical practice, people
get screened and tested for serious conditions all the time. People
get mammograms, they get biopsies, these can be done without these
bureaucratic hurdles. The several layers of paperwork, the required
counseling for HIV testing, they were actually a barrier."

For decades, medical facilities have required written consent and
counseling for HIV testing because AIDS was such a deadly disease and
there was a "substantial stigma" associated with it, Klausner said.

But with new treatments available and heightened public awareness of
AIDS, the strict pretesting process had become outdated and overly
formal, he said. Public health officials worried that the extra
precautions -- along with the wait time that required 20-minute
counseling sessions -- were discouraging people from getting tested.

Klausner said San Francisco's public health department began
dismantling its pretesting counseling program last summer, when the
city removed funding for counseling positions at public clinics and
hospitals. Since then, the medical providers actually conducting the
tests have been providing counseling.

Several AIDS organizations have expressed concerns about the CDC
proposal, which is still being discussed, suggesting that policies
like San Francisco's could threaten patient privacy, although
Klausner said that HIV testing will meet the same strict patient
confidentiality rules.

Steven Tierney, deputy executive director of the San Francisco AIDS
Foundation, said he supports programs that will encourage more people
to get tested, but he doesn't want the testing process to be
"over-simplified" to the point that people aren't making informed
decisions based on conversations with a counselor or their medical provider.

"Anything that makes it easier to get tested is a good thing, but we
believe folks have a right to full, informed consent," Tierney said.