Pubdate: Thu, 18 May 2006
Source: San Francisco Chronicle (CA)
Section: Page B - 3
http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/05/18/BAGHTITPRQ1.DTL
Copyright: 2006 Hearst Communications Inc.
Contact:  http://www.sfgate.com/chronicle/
Details: http://www.mapinc.org/media/388
Author: Erin Allday, Chronicle Staff Writer

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AIDS, the strict pretesting process had become outdated and overly 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.