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HIV testing effort may hit obstacles
 
 
  By MIKE STOBBE
the associated press
 
ATLANTA - Don't expect your doctor to nudge you toward an HIV test anytime soon, despite bold new government advice that most Americans be tested for the AIDS virus.
 
Public health experts say testing in many parts of the country probably won't get going for a year, maybe longer, because of a complex tangle of state laws and some family doctors' reluctance.
 
"I think it's going to be very slow progress," said Lawrence Gostin, a public health law professor at Georgetown University.
 
When the federal Centers for Disease Control and Prevention announced the guidelines last month, they were widely met with enthusiasm.
 
And they were supposed to take effect right away.
 
The goal is to prevent the further spread of AIDS and reach an estimated 250,000 Americans who don't realize they have HIV. The CDC is recommending testing for all teens and adults younger than 65 when they visit doctor's offices, emergency rooms and other health centers.
 
At least one major doctors group -- the 94,000-member American Academy of Family Physicians -- has declined to take a position on the CDC's advice, questioning the cost and whether it's necessary for everyone.
 
Even doctors who support the guidelines say it won't be as simple as the CDC hoped.
 
The idea was that by offering the test to virtually everyone, primary care doctors would be spared from counseling patients before the test and from obtaining specific consent to test for HIV. But New York and at least two dozen other states legally require pretest counseling or have other rules that may make it hard for doctors to follow the CDC advice.
 
"The whole point was to try to reduce the bureaucracy and administrative burden" for doctors giving HIV tests, Gostin said.
 
"But I don't think state laws will allow that," he said, adding that it may take years for some legislatures to ease restrictions.
 
"How challenging this is going to be depends on where [what state] the doctor practices," said Dr. Nancy Nielsen, a Buffalo, N.Y, physician who sits on the governing board of the American Medical Association.
 
And there's the daunting issue of dealing with a patient who has HIV, which some pediatricians and family doctors have rarely faced.
 
Many primary care doctors customarily refer a patient with HIV to a specialist better-equipped to treat the virus and put the patient in touch with support services. That's expected to continue.
 
But the primary doctor will be expected to break the news of the diagnosis to the patient. That task requires skills some physicians don't always demonstrate, said Dr. Kimberly Manning, an internist at Atlanta's large public hospital, Grady Memorial.
 
Physicians must be prepared to empathize, educate and guide HIV patients into such steps as notifying intimate contacts, she said.
 
 
 
 
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