Written informed-consent statutes and HIV testing.
BACKGROUND
Almost 1 million Americans are infected with HIV, yet it is estimated that as many as 250,000 of them do not know their serostatus. This study examined whether people residing in states with statutes requiring written informed consent prior to HIV testing were less likely to report a recent HIV test.


METHODS
The study is based on survey data from the 2004 Behavioral Risk Factor Surveillance System. Logistic regression was used to assess the association between residence in a state with a pre-test written informed-consent requirement and individual self-report of recent HIV testing. The regression analyses controlled for potential state- and individual-level confounders.


RESULTS
Almost 17% of respondents reported that they had been tested for HIV in the prior 12 months. Ten states had statutes requiring written informed consent prior to routine HIV testing; nine of those were analyzed in this study. After adjusting for other state- and individual-level factors, people who resided in these nine states were less likely to report a recent history of HIV testing (OR=0.85; 95% CI=0.80, 0.90). The average marginal effect was -0.02 (p<0.001, 95% CI=-0.03, -0.01); thus, written informed-consent statutes are associated with a 12% reduction in HIV testing from the baseline testing level of 17%. The association between a consent requirement and lack of testing was greatest among respondents who denied HIV risk factors, were non-Hispanic whites, or who had higher levels of education.


CONCLUSIONS
This study's findings suggest that the removal of written informed-consent requirements might promote the non-risk-based routine-testing approach that the Centers for Disease Control and Prevention (CDC) advocates in its new testing guidelines.
Department of General Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Peter D
PD
Ehrenkranz
José A
JA
Pagán
Elizabeth M
EM
Begier
Benjamin P
BP
Linas
Kristin
K
Madison
Katrina
K
Armstrong
D015492:AIDS Serodiagnosis / Q000331:legislation & jurisprudence / Q000523:psychology* / Q000706:statistics & numerical data; D000293:Adolescent; D040343:Behavioral Risk Factor Surveillance System; D002487:Centers for Disease Control and Prevention, U.S.; D003219:Confidentiality / Q000331:legislation & jurisprudence; D015986:Confounding Factors, Epidemiologic; D005260:Female; D015658:HIV Infections / Q000175:diagnosis; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D016015:Logistic Models; D008297:Male; D037141:Mandatory Programs / Q000331:legislation & jurisprudence*; D016743:Mental Competency; D008875:Middle Aged; D011159:Population Surveillance; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult