The US Centers for Disease Control and Prevention (CDC) recommendations in relation to routine HIV testing would contravene many US state laws requiring pre-test counselling and patient informed consent, according to an analysis published in the October edition of PLoS One (online science and medicine publication).

Since the CDC recommended routine HIV testing for all Americans between 13 and 64 years in September 2006, there has been few moves toward amending state laws to allow such testing and many states have in fact strengthened their position on the need for consent and counselling.

It is estimated that approximately a quarter of the one million HIV-positive people in the US are unaware of their status, and that this lack of awareness results in 20,000 new infections every year. According to the CDC recommendations, patients would have to be notified that they were being tested and would have the right to decline, but would no longer have to explicitly consent; neither would they receive pre-test counselling. However, in the US, legal issues pertaining to public health, including HIV testing policy, are predominantly under state jurisdiction. The CDC, while influential, does not have the authority to impose any changes on state testing regulations. Nineteen US states require specific oral consent (of which five require that consent be documented), 14 states require written consent, and eleven require pre-test counselling.

The analysis echoes previous criticisms that “the very limited disclosures the CDC recommends are insufficient for making informed decisions about testing,” that eliminating pretest disclosure and counselling may “remove an important mechanism for educating individuals about HIV and reducing risk”, and that the recommendations may in fact “weaken [patient] protections, without substantially increasing testing among those who are unaware that they are HIV-infected.”