Opt-out HIV Testing: Mixed Results

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The Centers for Disease Control and Prevention recommended routine “opt-out” HIV screening tests for health care settings in 2006. This means you automatically get an HIV test offered in most places you go for health care, but you can choose to opt out, or reject the test. There is a similar recommendation for jails. Health care providers have been slow to implement this recommendation. Recent articles in the medical literature discuss testing in various settings.

HIV-infected patients are at increased risk for cancer. Thus, authors at the Department of Veterans Affairs suggest that oncologists should routinely offer HIV screening for their patients. Those who test positive may expect better clinical outcomes with appropriate treatment for both conditions.

Emergency departments have made more progress in HIV screening. In a recent study, 28,042 patients were eligible for testing. Of these, 6,933 (25 percent) completed the testing, and 15 new infections were diagnosed.

Jails present an efficient location for HIV screening, since approximately 10 million Americans per year enter jails, usually for a a short time while awaiting trial. Two recent studies, one for a men's jail and the other for a women's jail, examined the optimum time to offer HIV tests. Inmates were divided into three groups, and offered a free test at one of the following times: (1) same day the person entered jail, (2) the next day, or (3) seven days after entry. Both men and women were most likely to accept testing when it was offered the day after entry into jail. Testing rates were higher for women. The percentages of inmates choosing to be tested in each group were as follows:
1. Men, Day 1: 45 percent
2. Men, Day 2: 53 percent
3. Men, Day 7: 33 percent
4. Women, Day 1: 55 percent
5. Women, Day 2: 73 percent
6. Women, Day 7: 50 percent

I hope someday HIV can be eradicated, as smallpox has been. Until then, the optimum way to find and treat infected individuals will be a subject of research and debate.

References:

1. Chiao EY et al, “Time for oncologists to opt in for routine opt-out HIV testing?” JAMA 2010 Jul 21; 304(3): 348-9.

2. Haukoos JS et al, “Routine opt-out rapid HIV screening and detection of HIV infection in emergency department patients”, JAMA 2010 July 21; 304(3): 284-92.

3. Katz DA et al, “Male perspectives on incorporating men into antenatal HIV counseling and testing”, PLoS One. 2009 Nov 2; 4(11): e7602.

4. Kavasery R et al, “A prospective controlled trial of routine opt-out HIV testing in a men's jail”, PLoS One. 2009 Nov 25; 4(11): e8056.

5. Kavesery R et al, “Routine opt-out HIV testing strategies in a female jail setting: a prospective controlled trial”, PLoS One. 2009 Nov 25; 4(11): e7648.

Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.