An interesting development in Oregon. HIV testing will now be treated as a standard diagnostic test and covered by general consent provided by a patient at the outset. In Australia, the new testing policy introduced last year changed the requirements prior to an HIV test from pre-test counselling/discussion to obtaining informed consent. We hear of cases here where, despite the policy, a person becomes aware of having been tested for HIV only after the test has been conducted, and we consider this to be bad.

In Oregon, the argment goes that informed consent should only be necessary in advance of procedures that carry “real risk”, and that this isn’t the case with an HIV test. Maybe, or maybe not. In my opinion, given the implications of a positive test result, informed consent should still be required in order that a tested person is fully aware of what a positive result means and can have a clear choice about whether they want a test or not.

Oregon House and Senate Unanimously Agree on New Changes to HIV Testing

Advocates expect HIV testing rates to increase as a result leading to earlier diagnosis and treatment

By:  Amanda Waldroupe

February 22, 2012—Both the House and Senate have unanimously passed a bill that will make HIV testing a part of routine blood work and other lab tests performed by a physician or hospital.

That change is expected to reduce the social stigma associated with HIV, transmission of the disease, as well as increase the number of people who are tested, according to legislators, providers and advocates of those living with HIV.

“[It] will greatly streamline the process of offering HIV testing broadly,” said Dr. Gary Oxman, Multnomah County’s public health officer. “This should lead to earlier diagnosis, improved prevention actions on the part of infected individuals and earlier treatment.”

“We believe this legislation is critical to finally bringing an end to the HIV epidemic in Oregon,” said Michael Kaplan, the executive director of Cascade AIDS Project.

Senate Bill 1507, which the House unanimously approved yesterday, now awaits the Governor’s signature. It allows patients to be notified in advance before given an HIV test with the option to decline either orally or in writing.

This bill also changes the statutory requirement in place since 1987, which made patients sign an informed consent form explicitly giving permission for the HIV test. That consent form is separate from a regular consent form, and part of the routine paperwork that a patient signs allowing doctors to perform “certain routine things that are pretty broad…that you need to have done,” said Sen. Alan Bates (D-Medford) who supported the bill,

Those routine tests include simple blood tests, urine samples and other labs. “If we didn’t have that kind of consent form in place, we’d have to have you sign a consent [form] for every little thing we’re doing in your treatment process, and we’d never get anything done,” Bates said.

Informed consent, on the other hand, is a more time intensive procedure that requires a discussion between the provider and patient about a particular procedure or treatment, such as surgery or having radiation or chemotherapy to treat cancer. Bates said that informed consent is typically reserved for procedures “that have real risks.”

The current law was put into place when the spread of HIV and AIDS was rampant, and there was a stigma associated with the disease and few treatments available. All of these factors have led to a “significant barrier” to increasing the rate of HIV testing, Oxman said.

Dr. Todd Korthuis, director of Oregon Health & Science University’s HIV prevention program, agreed, calling it “one of the most important barriers to performing routine HIV testing in healthcare settings.”

Noting that treatments available for HIV can stop its transmission, halt the disease from turning into AIDS, and allow people to live healthy lives for years, Bates said it was “time for our laws to catch up with our society and our values.”

To Sen. Jeff Kruse (R-Roseburg), Senate Bill 1507 begins to treat HIV “as it really is…another on a list of chronic, treatable, and communicable diseases. “It’s common sense,” he said. “Without this sort of measure, our ability to control the spread of such disease doesn’t really exist.”

The bill builds on a similar measure passed in 2005, which incorporated HIV testing into routine prenatal care for pregnant women.

Since 2006, the Centers for Disease Control (CDC) has recommended that states adopt policies that do not require informed consent in an effort to make HIV testing a routine medical procedure. Everyone between the ages of 13 to 64 should be tested in a healthcare setting unless they decline, according to the CDC.

Approximately 5,000 Oregonians live with HIV, and there are around 300 new infections each year, according to the Oregon Health Authority. Nationally, approximately 56,000 people become infected with HIV every year, and the CDC still considers the disease to be spreading at epidemic levels, and believes there are about one million people living with HIV in this country, yet only 25 percent know they have the disease.

A CDC study found that 65 percent of people who were tested for HIV only had the test after they came to the doctor’s office, emergency room, or other healthcare setting complaining of other illnesses.

That was the experience of Dr. Andrew Seaman, a third year internal medicine resident at Providence Portland, who helped write Senate Bill 1507. He told the Senate and House healthcare committees that he “had a string of patients presenting to my emergency department with findings of advanced AIDS” but who came to the emergency room complaining of other maladies, including lung infections.

According to Seaman, approximately 40 percent of Oregonians with HIV have a late stage of the disease when they are diagnosed, compared to the national average of 32 percent.

Cascade AIDS Project, the Oregon Medical Association, the American College of Physicians, and Multnomah County’s Health Department, along with independent health providers supported the legislation.

The only opposition came from the ACLU of Oregon, which argued that HIV testing should remain voluntary, through informed consent. Becky Straus, the organization’s legislator director, argued that having HIV testing “embedded in a general medical consent form,” would decrease a patient’s knowledge that the test may be performed.

“The reality is that many patients do not read, and many other patients attempt to read but do not fully understand, generic medical consent forms,” Straus said.

She argued that the stigma associated with HIV is still “an ongoing real problem,” and that HIV testing should continue to be distinct from other testing.

But legislators weren’t swayed by Straus’ argument. “Why, in this day and age, would this test be any different than any other diagnostic test?” asked Rep. Jim Thompson (R-Dallas), a co-chair of the House’s healthcare committee. “We don’t have any kind of exception…on any other diagnostic test.”

“A disease is a disease is a disease,” said Rep. Val Hoyle (D-Eugene), who added that she’s had a number of friends die from AIDS. “Treating this disease or how we test for how someone is HIV positive is saying that these people are actually different, that they should be segregated. I think what we need to do is treat this no differently than we would anything else.”

The Legislature’s unanimous passage of Senate Bill 1507 is a rare show of bipartisanship support this session.

Two important healthcare reform bills—Senate Bill 1580, which would allow the Oregon Health Authority to move forward with transforming the Oregon Health Plan’s delivery system, and House Bill 4164, which will allow Oregon’s health insurance exchange to proceed—are being held up by Republican legislators who insist that bills related to job creation be passed first.