Abstract
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.