I went to a meeting organized by the Washington Department of Health (DoH) to talk about proposed changes to the Washington Administrative Code (WAC). In Washington State (America) there is the Revised Code of Washington (RCW) which is a compilation of all the state laws in force. These laws were set in place at the state’s founding and the compilation can only be changed by a vote. The WAC is a set of rules that determine how the RCWs will be upheld. These are changed without a vote, generally by forming a committee which discusses a change and comes to a consensus.
The committee who was arranging these changes came to the Seattle Central Community College to get input about the changes they were proposing. The basis for the change was the CDC’s “Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Healthcare Settings,” so what they were trying to do was make the state administrative code more closely match the national standards.
To summarize, the proposed changes would make it easier for doctors to test people for HIV. As the law stands now, healthcare providers have an obligation to assume that their clients want a lot of privacy when deciding whether to test them for diseases. Because they make this assumption, they often do not do HIV testing unless a person asks for it. If doctors could assume that – for example – a person who comes in and says that they want a general checkup and testing for all common diseases will want to be tested for HIV as a part of this general exam, then more people will be tested. However, community members are often concerned about the meaning of mandatory reporting of positive HIV results to the Department of Health, so these proposed changes will conflict with some people’s personal rights. I do not currently have an opinion on this issue because it seems that both sides make convincing arguments, and because this debate is new to me.
There were 20 people at this meeting in addition to the DoH committee. I was the only person who was attending as a community member and not representing some agency. Most people were healthcare workers, and they all seemed in favor of removing restrictions on testing. The WAC contains rules that doctors must provide information about testing before testing, and their argument was that anytime a doctor has to do extra work it is more likely that he will avoid that work. So doctors do not recommend HIV testing because they do not have time to document that they provided the person with information, and furthermore some people do not want HIV testing because of the mandatory reporting that doctors do to the government whenever they find someone with HIV. The counterargument to these objections is that HIV testing needs to done to prevent the spread of HIV.
It seems to me that the best solution would be to remove barriers that deter medical providers from routinely conducting HIV testing on all their clients, however, there should be increased barriers on a person’s rights to keep their HIV status confidential after testing. I see nothing wrong with HIV status being reported to serve public health interests, but I can also imagine scenarios when a person’s rights could be harmed if non-public health interests had access to these records. I think that if there were a national database for collecting and protecting HIV status then that would be best, but a project of that scale would be as complicated as any national ID program and people would demand the same level of confidentiality as they would for their social security numbers or any similar tracking system.