Dispelling Myths About the CDC's New Recommendations Regarding HIV Testing, Informed Consent, and Pre-Test Counseling

Dispelling Myths: Consent for Testing

What the CDC Says:

• HIV testing must be voluntary.
• Patients must know that testing is planned and be informed that they will be tested unless they decline (“opt out”).
• The patient should be provided information about HIV infection and the meanings of positive and negative test results and be provided an opportunity to ask questions and decline testing.
• General informed consent for medical care is sufficient to encompass informed consent for HIV testing.

What the CDC Does Not Say:

• CDC does not state that people canbe tested without their knowledge or withoutproviding informed consent. Informedconsent for medical treatment is required bylaw and by medical ethics.
• Given the CDC’s acknowledgmentthat testing must be voluntary and informed,its reference to “general informed consent formedical care” appears to relate solely to itsview of how consent must be documented.
• Many advocates and others questionwhether testing under an “opt out” programwill be fully voluntary. The CDC has notanswered this question.

Dispelling Myths: Counseling Prior to Testing

What the CDC Says:

• CDC recommends that “preventioncounseling” not be required prior to testing.It defines “HIV-prevention counseling” asinvolving individual risk assessment anddevelopment of a plan to reduce those risks.
• CDC acknowledges that obtaininginformed consent for HIV testing involvesproviding information about HIV, the risksand benefits of testing, the implications of testresults, how test results will becommunicated, and the opportunity to askquestions.

What the CDC Does Not Say:

• CDC is not recommending that therebe no counseling prior to testing. Itrecommends only that a very specific form ofcounseling -- focused on individualized riskassessment and reduction -- not be provided.
• CDC is not saying that all statecounseling requirements conflict with itsrecommendations. In fact, some state lawsrequire that pre-test counseling provide thesame pretest information that CDCrecommends (an explanation of HIVinfection and the meanings of positive andnegative test results).

Dispelling Myths: The Status of the Recommendations

What the CDC Says:

• CDC clearly labels these as“recommendations,” not “requirements.”
• CDC acknowledges that some states,local jurisdictions, or agencies have legalrequirements related to consent or counselingthat conflict with some of therecommendations and that thoserecommendations cannot be implementedunless such conflicts are resolved.
• These recommendations do notmodify existing guidelines for HIV testing innon-clinical settings (e.g., community-basedorganizations, outreach settings).

What the CDC Does Not Say:

• CDC does not say that theserecommendations must be followed.
• CDC does not say that itsrecommendations are the only means ofincreasing testing. In fact, it referencesstudies in which increased, non-risk based,testing was achieved without abandoningspecific written consent and/or pre-testcounseling.