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June 13, 2007

Consent Policies and Rates of HIV Testing

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297(22):2478-2479. doi:10.1001/jama.297.22.2478-b

To the Editor: In their Research Letter, Dr Zetola and colleagues1 reported that human immunodeficiency virus (HIV) testing rates and number of positive tests increased significantly in San Francisco after the requirement for written informed consent was eliminated. However, our experience has been different.

Since 1985, confidential HIV testing has been available in Latium Region free of charge, after a pretest visit in public counseling and testing sites. Starting in January 1989, the Regional Health Department allowed persons referred by other nonspecialist physicians (eg, general practitioners) to obtain an HIV test without a pretest visit; all tested persons still have had to receive their test results during a posttest visit. In 1985-1989, the number of persons tested for HIV in our counseling and testing site in a 6-month period ranged between 180 and 460, without any significant trend over time, although this number increased progressively after the 1989 policy change and 1006 persons were tested in the second half of 1990.2 However, in contrast with what was observed in San Francisco, the number of persons testing positive remained fairly constant. We found that persons who were tested without pretest counseling had a different demographic and behavioral profile and a lower HIV positivity rate compared with those tested after pretest counseling.