Federal agencies may be moving closer to requiring routine HIV screening for American citizens. The U.S. Preventive Services Task Force, an independent consortium of experts sponsored by the Department of Health and Human Services, proposed new guidelines this week that encourage testing patients for HIV during ordinary checkups. Like several of the in-class presentations, these guidelines raise new issues concerning privacy, public policy, and medical necessity.
The number of unaware HIV carriers is startling: of the one million Americans with HIV, one in five is ignorant of his condition. Unknowingly carrying HIV obviously imperils the patient’s own health, while also threatening to spread to others. Testing, on the other hand, is minimally invasive. Doctors can detect HIV during ordinary blood analysis, use a special swab over a patient’s gums, or even offer a do-it-yourself swab kit.
Required testing offers several policy benefits. Making the tests routine alleviates the perceived stigma patients feel when requesting HIV testing from a doctor. Uniform across-the-board testing dispels any accusation that scientists are only targeting a particular group (current policy has been criticized for disproportionality focusing on homosexual men and drug users). Further, the cost of testing could be covered as preventive care under the new healthcare provisions.
The guidelines raise a broader and recurrent theme from class. Namely, the sometimes unsettling process of government regulations on medical and scientific procedures must be weighed against the potential public good. Here, the prevention of AIDs is hardly controversial, but the stigma surrounding the disease endures. These guidelines will surely prove more controversial than, for instance, required periodic cancer or cholesterol screening. Yet the recommendations are buttressed by the credibility of an independent task force, largely apart from the ordinary political process. Faced with far more difficult questions of medical and scientific ethics than these, let’s hope the choice to identify nearly a quarter-million Americans with HIV is a relatively easy one.