The Illogic of Secret AIDS Testing
An investigation by a UCLA professor of medicine has found widespread use of clandestine AIDS testing by hospitals in the United States, a procedure that violates the law in many states, including California, and runs counter to standards of ethics and appropriate practice. The practice betrays an unwelcome panic among professionals regarding the disease.
Informed consent is appropriate for any such testing. Furthermore, the testing should include counseling of the patient both before the test and when the results are shared. But those hospitals undertaking the secret tests apparently are more concerned with the safety of the medical staff than with the well-being of the patient, according to the study. Most deny that the tests are undertaken. The results generally are not shared with the patient. On occasion the results have led to alterations in hospital procedures or the transfer of patients to other hospitals.
“I think everyone’s concerned about being exposed,” Dr. Charles E. Lewis, author of the report, said. That is understandable. But the concern does not justify this practice. Indeed, the secret testing could be counterproductive, encouraging a false sense of security by staff when treating persons who have tested negative to the human immunodeficiency virus (HIV) that causes AIDS. The test does not always reveal infection. That is why federal regulations have provided appropriate procedures to protect health-care providers. The procedures should be followed without regard to test results.
No health-care work is without risk. Doctors, dentists and nurses face graver risks than AIDS, however. The Centers for Disease Control counts a total of 19 health-care providers who have become infected with HIV over the years, compared with a much higher annual death toll related to acute hepatitis B infection. The CDC estimates that 15 health-care workers die each year from hepatitis infection, and an additional 240 from liver cancer or cirrhosis of the liver attributable to an earlier infection with hepatitis B. Given such statistics, the medical logic for secret AIDS tests is extremely elusive.
