Pennsylvania has revised its HIV testing law in an effort to increase early detection and treatment of people infected with the AIDS virus.
The changes - the subject of intense debate and lobbying for two years - are in line with 2006 federal recommendations aimed at making HIV screening a routine part of health care rather than a stigmatized test given to "high risk" individuals in special clinics.
The Centers for Disease Control and Prevention estimate that a fifth of HIV-positive Americans are unaware of their infection. Meanwhile, HIV has spread beyond the traditional high-risk groups - gay men and intravenous-drug users - to the heterosexual population.
"Detecting the HIV-positive person is not only important for that person but for the public health," said Temple University Hospital physician Mary van den Berg-Wolf, an HIV specialist who lobbied for the changes.
"More than half of new infections are transmitted," she said, by "people who don't know they're HIV-positive."
On Wednesday, she and other advocates celebrated the amendment at a meeting with Gov. Corbett, who signed it into law July 7.
Starting Sept. 6, it makes several changes in Pennsylvania, where 31,000 people were living with HIV and 18,700 with AIDS in 2009:
Health-care providers may inform patients orally or in writing that HIV testing will be performed unless they decline or opt out. Currently, patients must opt in for testing and give written consent.
Consent will be "documented," meaning the health-care provider will note it in the patient's record.
Although the nature and limits of the test must be explained to the patient, pretest counseling about risky behaviors will no longer be mandated.
Test results, now given in person, may be delivered over the phone. However, the regulation states, "no positive test result shall be revealed . . . without affording the . . . immediate opportunity for individual, face-to-face counseling" about health services and HIV prevention.
While HIV-related laws vary, all states except Massachusetts have stopped requiring patients to sign an informed-consent document authorizing testing, van den Berg-Wolf said.
The easing of consent provisions worries the AIDS Law Project of Pennsylvania.
"We are completely in favor of increasing testing," said Ronda B. Goldfein, the project's executive director. "But 'documented consent' isn't explained. All that means is that the doctor wrote that I consented. It doesn't mean I actually consented."
In the worst case, Goldfein said, some people will get life-shattering results from a test they didn't realize they had submitted to.
But the counterargument, which held sway, is that HIV is no longer the death sentence it was in the 1980s. Treatment not only saves lives, but also dramatically reduces the risk of transmission. And treatment begins with a positive test result.
"You can argue the equation has changed," said Jane Shull, executive director of Philadelphia FIGHT, an AIDS services organization. "Not only is there treatment, but earlier and earlier treatment appears to be important to do."