Another Thing That's Undeniably Improved in Medicine: Getting an HIV Test
A Happy Birthday to a landmark policy change
Dr. Sax is a Professor of Medicine at Harvard and the Clinical Director of the Division of Infectious Diseases at Brigham and Women’s Hospital in Boston. Dr. Sax writes a terrific blog for the New England Journal of Medicine and a Substack.
Recently, Dr. Sax has been writing about things that have undeniably improved in medicine. Today, I am very happy to share the latest post from this series. This article awakened the PTSD from the darkest days of the HIV epidemic, but I also found it applicable to recent events in which decisions made sense when considered through a narrow focus, but were harmful from a broader, more global perspective.
(The full version of this post is available to our paid subscribers today. The full text will be available for free to all on Dr. Sax’s Substack next week.)
Adam Cifu
When I think back on my career of mine as an ID specialist, hardly anything stands out as more perplexing than the barriers we set up for clinicians to order an HIV test.
To be blunt: What the hell were we thinking?
You see, for over 20 years after the licensing of the first HIV test in 1985, the process of getting an HIV test on a patient involved a convoluted series of actions that all but defined the term “HIV exceptionalism” — meaning something we did for HIV, and no other diseases.
Want to order an HIV test? Here’s what it actually took to get an HIV test at our hospital:
Have doctors, lawyers, ethicists, and patient advocates draft a consent form that satisfies all interested parties, yet ensures it will be so long and complex that no one will read it in its entirety.
Go find the consent form in the hospital’s repository of various approved papers, documents, and consents.
Hand the form to the patient you’d like to get the blood test; wait for them to read it; answer their questions; and watch them sign and date it in the designated spot.
Countersign the form in your designated spot, and acknowledge (in check boxes) that you’ve gone over the pros and cons of testing, that you’ve offered them the chance to ask questions, that you’ve educated them about the difference between HIV and AIDS (HIV consent forms had a bizarre obsession with this distinction), and that you’ll keep the information confidential.1
Give the patient the original, but send one copy of the consent form to medical records, and give them the third copy to take to the blood draw station, but first put it in a special yellow envelope that says CONFIDENTIAL on it, which was ridiculous since we didn’t use that envelope for any other test, hence defeating the purpose of the envelope because anyone carrying that envelope was, obviously, getting an HIV test.
And this was all before the blood was even drawn.
