title: Patient and clinician ethical perspectives on the 2006 Centers for Disease Control and prevention HIV testing methods.
abstract: OBJECTIVE
  CDC 2006 recommendations for new HIV testing methods in U.S. health-care settings (opt-out approach, general medical consent, and optional prevention counseling) have been the subject of a public ethical debate. Ethical concerns might limit their implementation and affect expanded HIV screening efforts. We compared clinicians' and patients' perspectives on the ethical concerns raised about, justifications provided in support of, and preferences for the 2006 CDC-recommended HIV testing methods for the U.S. health-care setting, in contrast with the 2001 CDC-recommended HIV testing methods (opt-in approach, specific written consent, and mandatory prevention counseling).
  
  
  METHODS
  We conducted a non-inferiority trial and survey of 249 clinicians and random samples of 1,013 of their patients at three emergency departments and three ambulatory care clinics at university-affiliated hospitals in Rhode Island from June to December 2007.
  
  
  RESULTS
  Clinicians found the 2006 CDC HIV testing methods to be more ethically concerning than the 2001 testing methods (i.e., ethically inferior), while patients had few ethical concerns. In regard to ethical justifications cited for the 2006 CDC HIV testing methods, clinicians were more supportive of the ethical justifications cited for using an opt-out approach and general medical consent, while patients were more supportive of the justifications for optional HIV prevention counseling. Clinicians showed a relatively greater preference for the opt-out approach and use of general medical consent, while patients had a relatively greater preference for optional HIV prevention counseling.
  
  
  CONCLUSIONS
  Clinicians and their patients hold divergent ethical perspectives on CDC's 2006 HIV testing methods. The results indicate an opportunity to review not only these but also future HIV testing recommendations, as well as how they are presented for implementation.
authors.affiliation: Brown University, Alpert Medical School, Department of Emergency Medicine, Providence, RI, USA. rmerchant@lifespan.org
authors.forename: Roland C
authors.initials: RC
authors.lastname: Merchant
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Waxman
authors.forename: Julie G
authors.initials: JG
authors.lastname: Maher
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Clark
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Celada
authors.forename: Tao
authors.initials: T
authors.lastname: Liu
authors.forename: Emma M
authors.initials: EM
authors.lastname: Simmons
authors.forename: Curt G
authors.initials: CG
authors.lastname: Beckwith
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
mesh_terms: D015492:AIDS Serodiagnosis / Q000941:ethics*; D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002487:Centers for Disease Control and Prevention, U.S. / Q000592:standards*; D003376:Counseling / Q000941:ethics; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D017410:Practice Guidelines as Topic; D012237:Rhode Island; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult