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Consistency of State Statutes With the Centers for Disease Control and Prevention HIV Testing Recommendations for Health Care Settings

Anish P. Mahajan, MD, MPH; Lara Stemple, JD; Martin F. Shapiro, MD, PhD; Jan B. King, MD, MPH; and William E. Cunningham, MD, MPH
[+] Article, Author, and Disclosure Information

From the David Geffen School of Medicine, School of Law, and School of Public Health, University of California, Los Angeles, and Los Angeles County Department of Public Health, Los Angeles, California.

Acknowledgment: The authors thank Cristina Punzalan and the UCLA-Robert Wood Johnson Clinical Scholars Program staff. They also thank Jose Escarce, MD, PhD; Robert Brook, MD, ScD; and Thomas Coates, PhD, for their guidance during the development of this project and useful comments on earlier drafts of this manuscript.

Grant Support: By the Robert Wood Johnson Clinical Scholars Program (Dr. Mahajan); Charles Drew/University of California Los Angeles Project EXPORT National Institutes of Health grant P20 MD 000182-06 (Drs. Shapiro and Cunningham); and University of California Los Angeles/Drew Resource Centers for Minority Aging Research/Center for Health Improvement of Minority Elderly National Institutes of Health grant P30AG021684 (Dr. Cunningham).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Anish P. Mahajan, MD, MPH, The Robert Wood Johnson Clinical Scholars Program, David Geffen School of Medicine at University of California, Los Angeles, 911 Broxton Avenue, Los Angeles, CA 90024; e-mail, AnishMahajan@mednet.ucla.edu.

Current Author Addresses: Dr. Mahajan: The Robert Wood Johnson Clinical Scholars Program, David Geffen School of Medicine at University of California, Los Angeles, 911 Broxton Avenue, Los Angeles, CA 90024.

Ms. Stemple: University of California, Los Angeles, School of Law, 405 Hilgard Avenue, Los Angeles, CA 90095.

Drs. Shapiro and Cunningham: Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, 911 Broxton Avenue, Los Angeles, CA 90024.

Dr. King: County of Los Angeles, Department of Public Health, Office of AIDS Programs and Policies, 600 South Commonwealth Avenue, 10th Floor, Los Angeles, CA 90095.

Ann Intern Med. 2009;150(4):263-269. doi:10.7326/0003-4819-150-4-200902170-00007
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In September 2006, the Centers for Disease Control and Prevention (CDC) released the “Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-care Settings” to improve screening and diagnosis. The CDC now recommends that all patients in all health care settings be offered opt-out HIV screening without separate written consent and prevention counseling. State law on HIV testing is widely assumed to be a barrier to implementing the recommendations. To help policymakers and providers better understand their own legal context and to correct possible misunderstandings about statutory compatibility, a state-by-state review (including Washington, DC) of all statutes pertaining to HIV testing was performed and the consistency of these laws with the new recommendations was systematically assessed. Criteria were developed for classifying state statutory frameworks as consistent, neutral, or inconsistent with the new recommendations, and the implications for implementation of the CDC recommendations in these various legal contexts were examined. The statutory frameworks of 34 states and Washington, DC, were found to be either consistent with or neutral to the new CDC recommendations, which would enable full implementation. Statutory frameworks of 16 states were inconsistent with the new CDC recommendations, which would preclude implementation of 1 or more of the novel provisions without legislative change. In the 2 years since release of the recommendations, 9 states have passed new legislation to move from being inconsistent to consistent with the guidelines. State statutory laws are evolving toward greater compliance with the CDC recommendations. Policymakers, provider groups, consumer advocates, and other stakeholders should ensure that HIV screening practices comply with existing state law and work to amend inconsistent laws if they are interested in implementing the CDC recommendations.


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Consistency of state statutory frameworks with the Centers for Disease Control and Prevention's revised recommendations for HIV testing in health care settings.

As of 1 November 2008, 16 states have at least 1 law that is a barrier to implementation (inconsistent), 20 state statutory frameworks are silent on or do not conform to or contradict each of the provisions of the recommendations (neutral), and 15 states have laws that are consistent with 1 or more provisions of the recommendations and no law that is a barrier (consistent).

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CDC Recommendations and the Compendium of State HIV Testing Laws
Posted on March 17, 2009
Sarah E Neff
University of California, San Francisco
Conflict of Interest: None Declared

We read with great interest the article by Mahajan, et al., "Consistency of State Statutes with the Centers for Disease Control and Prevention HIV Testing Recommendations for Health Care Settings" (1). As the authors state, there has been little discourse on the evolution of state HIV testing laws since the issuance of the 2006 CDC recommendations (2), leaving many clinicians confused about their state-specific guidelines and whether they conform with the CDC recommendations.

We are concerned that the article can be misinterpreted by clinicians seeking guidance in this difficult arena. For example, Mahajan et al. classify Alabama as inconsistent with CDC recommendations because its laws require "specific, written consent;" however, Alabama's statutes also specify that consent may be included in general consent for medical or surgical treatment, which can be interpreted as "consistent." Moreover, there are differences within state laws pertaining to different testing scenarios for different populations (e.g., pregnant women, minors), facilities (e.g., emergency departments, counseling and testing sites, substance abuse treatment centers), health care providers, (e.g., physicians, nurses, physicians' assistants) that are not specified in the article, further complicating matters for clinicians.

The Compendium of State HIV Testing Laws from the National HIV/AIDS Clinicians' Consultation Center (NCCC) at www.nccc.ucsf.edu can help clinicians seeking clarification of how their state laws and the CDC recommendations apply in clinical practice. The Compendium comprehensively presents clinicians with regular updates to each state's HIV testing laws. Since Mahajan, et al. cited the Compendium, it has already undergone three major updates, illustrating the benefit of such a living document.


1. Mahajan AP, Stemple L, Shapiro MF, King JB, and Cunningham WE. Consistency of state statutes with the Centers for Disease Control and Prevention HIV testing recommendations for health care settings. Ann Intern Med. 2009;150:263-269.

2. Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al; Centers for Disease Control and Prevention (CDC). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55:1-17; quiz CE1-4. [PMID:16988643]

Conflict of Interest:

None declared

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