Can HIV Testing Be Required Prior to Medical Treatment?

A health care worker follows universal precautions.

HIV stands for Human Immunodeficiency Virus. It is the virus that causes Acquired Immune Deficiency Syndrome (AIDS). HIV is transmitted through the exchange of bodily fluids Since the start of the epidemic, some people in the United States have advocated mandatory or compulsory HIV testing for anyone seeking health care.

History

AIDS made its first appearances in 1981 among the gay male populations of New York and Los Angeles, though it quickly became clear that other groups, such as hemophiliacs and injection drug users, were also at risk. Some panicked health care workers refused to treat people in high risk groups. In 1985, the first blood test for AIDS became available and many people, including former President Reagan who had remained eerily silent about the epidemic for years, came out in favor of mandatory testing.

Benefits

Proponents of mandatory testing perceived many benefits. First, they thought such testing would alert health care workers to potential threats. Second, they hoped to prevent infected people from spreading HIV unknowingly to their partners and drug buddies. Third, they reasoned that compulsory testing would allow HIV patients to start getting treatment earlier. Finally, as more became known about HIV transmission in pregnancy, advocates claimed that a mother who knew she carried the virus could start on medication and reduce the risk of transmission to her child.

Warning

In the early years of the epidemic, and even to some extent in the new millenium, people who were HIV-positive faced horrible discrimination. Some were beaten; others were denied health insurance and health care; many others were turned out of their jobs, homes and families. AIDS activist groups argued that compulsory testing wouldn't enhance compassionate care; it would merely put a target squarely on the backs of sick people. Groups like ACT-UP (AIDS Coalition to Unleash Power) protested loudly and publicly, and slowly the people in favor of mandatory testing began to back down.

Compromise

Today the Centers for Disease Control (CDC) strongly recommends, but does not require, that all adults undergo regular screening for HIV and that those who engage in high-risk behaviors be tested as often as once a year. In reality, as of June 2009, more than half the adults in the U.S. reported never having been tested for HIV.

Universal Precautions

All health care workers are expected to protect themselves from the threat of HIV by taking universal precautions. This means that they act as if any fluid they come into contact with could be infected, so they wear gloves, gowns, and masks to avoid skin contact with all bodily fluids. Today it is no longer acceptable for a health care worker to refuse to provide care based on a person's HIV status.

Compulsory Testing in the United States

There are a few rare situations when individuals do have to undergo mandatory HIV tests. Blood and organ donors, for instance, must be tested, as must active duty military personnel. Some federal and state prisoners, such as those convicted of sex crimes, are tested for HIV. Finally, in some states, newborns with mothers of unknown HIV status are automatically tested so they can begin medical treatment right away. However, the average person seeking help from the health care system is not required to undergo HIV testing prior to treatment.

References

• Henry J. Kaiser Family Foundation. HIV/AIDS Fact Sheet. June 2009
• AVERT: History and Science of HIV and AIDS