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Mass. Senate backs bill on HIV testing consent

By Bob Salsberg
Associated Press / March 1, 2012
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BOSTON—State senators voted Thursday to relax regulations that require patients to consent in writing before they can be tested for HIV, the virus that causes AIDS.

Massachusetts is one of only two states that mandate written consent for HIV screening, a policy that the federal Centers for Disease Control has specifically recommended against.

The bill, approved on a voice vote, would replace the provision in a 1986 state law requiring written informed consent with verbal informed consent, a change that would bring the state closer to guidelines approved by the CDC in 2006 that call for voluntary routine screening for HIV infection for all people aged 13-64, with more frequent testing of high-risk individuals such as drug users or those with multiple sex partners.

But the legislation leaves intact -- at least for now -- a separate requirement that patients give written consent before doctors could share any HIV-related medical information with other health care providers. The Massachusetts Medical Society, which represents about 23,000 physicians, has called strongly for changes in that provision, as well.

Supporters of the bill, which now goes to the House, said the switch from written to verbal consent for testing could significantly expand the number of people screened for HIV in Massachusetts, by making it easier for doctors to test and by removing for patients some of the anxiety surrounding the test.

"It's important to do this right now because there are probably about 5,000 people in Massachusetts who have HIV but don't know it because they haven't been tested," said Sen. Patricia Jehlen, D-Somerville, the lead author of the bill who spent months trying to broker a compromise between sometimes competing medical and privacy concerns.

Early detection of HIV can lead to drug therapies that greatly slow the onset of full-blown AIDS and also reduce the risk that infected people will transmit the virus to others, doctors say.

Jehlen said HIV testing in San Francisco increased 44 percent after a written consent requirement was removed there.

"We cannot end the AIDS epidemic in Massachusetts if those who are HIV positive are unaware of their status," said Rebecca Hoag, president of the AIDS Action Committee, after Thursday's vote.

Nebraska is the only other state with a written consent requirement for HIV testing. The bill's supporters noted that testing for all other infectious diseases is covered by a general consent given by patients.

The CDC recommends that patients be informed before any HIV test and be allowed to opt out of such screening. The guidelines call for doctors to make a note in a patient's record only if they opt out.

The Massachusetts bill differs in that it would require doctors to note in the patient's record whether they agree to or refuse the screening.

Jehlen promised that privacy concerns related to the release or sharing of HIV-related medical information would be addressed by lawmakers in the future.

The Massachusetts Medical Society had asked senators to make HIV testing a part of routine medical care, not only by removing the written consent requirement for screening but also easing restrictions on the sharing of information among doctors. The group argued that because many HIV patients visit multiple doctors, it was critical that health care providers be allowed to share data.

"A separate system for all HIV-related information shuts the clinical record and makes quality care for people with HIV difficult if not impossible," the society's president, Dr. Lynda Young, wrote in a commentary on the group's website this week. She added that the restrictions would impede the ongoing changeover to electronic medical record-keeping.

Activists who argue for stronger privacy controls say there remains a stigma around the virus -- first identified in the U.S. more than three decades ago -- and that patients still fear disclosure could cost them their jobs, homes or health insurance.

Doctors say those concerns are addressed by federal medical privacy laws and laws against discrimination.

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