for Health Care Providers
Update on HIV Testing and Patient Consent Issues
Q1: What does this change mean?
HIV testing in the VA used to require that patients get a scripted explanation of HIV testing and sign a form before an HIV test was performed. Once the change takes effect, providers will still discuss HIV testing with patients before testing takes place, but providers will not be required to use standardized, pre-test counseling. Also, patients will give their permission for HIV testing verbally--rather than signing a consent form. (July 16, 2009)
Q2: Why is VA making this change?
To improve Veterans' health care, the VA is bringing its policies on HIV testing in line with recommendations from the US Centers for Disease Control and Prevention (CDC). The CDC has recommended that all patients be offered HIV testing, regardless of whether they think they are at risk, and that written informed consent for HIV testing not be required. Written informed consent for HIV has been associated with barriers to timely HIV testing and the early diagnosis of HIV. Because early HIV diagnosis is associated with improved medical outcomes, VA would like to offer HIV testing to as many Veterans as possible, and dropping the requirement for written informed consent is part of this process. (July 16, 2009)
Q3: When will this change occur?
The regulation making this change takes effect on August 17, 2009.
Q4: How will consent be obtained once this change happens?
Patients will receive educational materials before giving consent, and their provider will discuss HIV testing with them. If the patient provides verbal consent, his or her provider will document the consent in the chart and order the test. (July 16, 2009)
Q5: How will VA put this change into place?
VA has been preparing for this change for many months. VA clinical providers and staff are being notified by e-mail, in writing, and through the VA's Web site. VA staff will receive new procedures and training materials for HIV testing. (July 16, 2009)
Q6: If I am a patient, can I be tested for HIV without my knowledge or consent?
NO, you cannot be tested without your verbal consent. If you are unconscious or otherwise unable to make decisions about your care, your surrogate (a spouse, relative, or friend who is legally allowed to make decisions on your behalf) will be asked for permission. In an emergency situation, a senior VA clinician can authorize HIV testing of an unconscious patient. (July 16, 2009)
Q7: If I am a patient, can I decline HIV testing?
Yes, the test is completely voluntary. (July 16, 2009)
Q8: If I am a patient, can I be denied care if I refuse HIV testing?
Absolutely not. You always have the right to refuse HIV testing and any other medical test without losing medical benefits or any right to care. (July 16, 2009)
Q9: If patients are no longer provided with standardized pre-test counseling, how can they make informed decisions about HIV testing?
Instead of the standardized pre-test counseling previously offered, patients will be provided with educational materials on HIV and HIV testing. VA also encourages patients to ask providers questions about HIV testing before they give consent. (July 16, 2009)
Q10: If I am a patient, can I withdraw my verbal consent for HIV testing?
Yes. As with any test, you can cancel your consent at any time before the test is performed by telling your provider. (July 16, 2009)
Q11: When VHA changes its policy to permit verbal informed consent rather than written consent for HIV testing, will it be permissible to ask for consent for HIV testing in case of a needlestick or other exposure before a patient undergoes a surgical or other procedure?
No. This practice, referred to as "contingent consent," is not permitted under VA informed consent regulations and policy. Requesting testing or contingent consent in the pre-operative setting may be interpreted as being a condition for receiving appropriate surgical care, and is thus coercive and not ethical. Veterans may not be denied necessary medical care based on HIV status, and Standard Precautions to prevent exposure to blood-borne pathogens should always be employed regardless of the patient's HIV infection status. (July 16, 2009)
Q12: Where can I get more information?
More information can be found on the HIV Testing topic page.