Pubdate: Thu, 18 May 2006 Source: San Francisco Chronicle (CA) Section: Page B - 3 http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/05/18/BAGHTITPRQ1.DTL Copyright: 2006 Hearst Communications Inc. Contact: http://www.sfgate.com/chronicle/ Details: http://www.mapinc.org/media/388 Author: Erin Allday, Chronicle Staff Writer CITY HEALTH AGENCIES MOVE TO STREAMLINE HIV TESTING San Francisco Drops Counseling Requirement San Francisco's public medical clinics and hospitals will no longer require written consent and counseling sessions before HIV tests, and public health officials say they hope the easier, less time-consuming process will prompt more people to get tested. The shift in policy, which took effect Tuesday, follows a similar proposal from the Centers for Disease Control in March, as the health care industry grapples with estimates that more than 20 percent of those infected with HIV don't know it -- and continue to spread the disease. San Francisco is the first city in the country to adopt the new policy, under which people will have to give verbal, not written, permission for testing. Pretesting counseling will still be offered to those who want it, but it will no longer be mandatory, said Dr. Jeffrey Klausner, director of STD Prevention and Control for the San Francisco Department of Public Health. Last year, 20,000 people were tested for HIV in San Francisco, and 440 of them tested positive, Klausner said. "When I reviewed testing records earlier this year I was shocked to see a substantial proportion of people were not testing for bureaucratic reasons," Klausner said. "In medical practice, people get screened and tested for serious conditions all the time. People get mammograms, they get biopsies, these can be done without these bureaucratic hurdles. The several layers of paperwork, the required counseling for HIV testing, they were actually a barrier." For decades, medical facilities have required written consent and counseling for HIV testing because AIDS was such a deadly disease and there was a "substantial stigma" associated with it, Klausner said. But with new treatments available and heightened public awareness of AIDS, the strict pretesting process had become outdated and overly formal, he said. Public health officials worried that the extra precautions -- along with the wait time that required 20-minute counseling sessions -- were discouraging people from getting tested. Klausner said San Francisco's public health department began dismantling its pretesting counseling program last summer, when the city removed funding for counseling positions at public clinics and hospitals. Since then, the medical providers actually conducting the tests have been providing counseling. Several AIDS organizations have expressed concerns about the CDC proposal, which is still being discussed, suggesting that policies like San Francisco's could threaten patient privacy, although Klausner said that HIV testing will meet the same strict patient confidentiality rules. Steven Tierney, deputy executive director of the San Francisco AIDS Foundation, said he supports programs that will encourage more people to get tested, but he doesn't want the testing process to be "over-simplified" to the point that people aren't making informed decisions based on conversations with a counselor or their medical provider. "Anything that makes it easier to get tested is a good thing, but we believe folks have a right to full, informed consent," Tierney said.