As HIV Spreads, Michigan and U.S. Differ on Testing

Last in a four-part series on AIDS in Michigan.

An estimated 17,000 Michigan residents know they are infected with HIV, and 900 more will test positive for HIV this year, predicts the Michigan Department of Community Health (MDCH). Yet the agency also estimates that less than 40 percent of the population is getting tested for the virus, and 25 percent of people infected with HIV in the state do not know they have it.

But the MDCH has failed to implement federal guidelines that could help detect HIV infection. Earlier detection leads to healthier lives for people who are HIV positive and decreases the likelihood they will spread the virus, say experts — including the MDCH. An MDCH policy statement issued last March cites three studies that show many HIV-positive individuals who had medical checkups were not diagnosed with HIV until years after they were infected. 

The failure to get broader testing led the federal Centers for Disease Control and Prevention (CDC) to recommend in September 2006 that HIV testing become part of the standard physical for all people ages 13-64. The CDC wants testing to be required unless a patient specifically says he or she doesn’t want to be tested.

The MDCH opposes the implementation of the CDC recommendations, however.

Continued -
  “We feel (the CDC recommendations) can be implemented successfully in the state without changing the law,” said Debra Szwedja, acting director of the MDCH’s Division of Health, Wellness and Disease Control.

Current Michigan law allows HIV testing be done only with informed consent, meaning patients are required to sign a consent form, and the medical personnel giving the test have to inform patients that the HIV tests will be done, inform them about their rights as patients and tell them to whom the test results can be made available. State law mandates that testing locations also must provide a copy of the booklet “Important Health Information,” which was created by the state and distributed by the MDCH. 

Szwedja said another obstacle to universal testing for HIV is the current third-party-payer insurance system. Some insurance policies will not cover routine HIV testing. To be covered, the test must be used as a diagnostic tool. But to qualify as a diagnostic test, a patient already must have symptoms of HIV infection.

Szwedja was quick to add that free testing is available at every county health department in the state, and that the MDCH has funded 20 test sites to perform HIV testing. “Anyone wanting an HIV test can walk into their county health department and get a free HIV test,” Szwedja said.

While the state continues to encourage medical facilities to do HIV testing, without eliminating the informed-consent procedures, it has shown significant success using this model with a specific risk group: pregnant women.

Under Michigan law, all women are to be counseled about HIV and encouraged to be tested for the virus as part of routine prenatal care. This process has helped to reduce the number of cases of HIV transmission from mother to child. In fact, the AIDS Fund Report Card on HIV/AIDS in Michigan, issued last week, gives the state an A for this category of prevention.