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^U.S. Drafts Guidelines Urging Patient Testing for AIDS (Washn)<

^By Malcolm Gladwell=

^(c) 1991, The Washington Post=

WASHINGTON _ The federal Centers for Disease Control on Thursday issued

draft guidelines recommending that all hospitals ``routinely offer and

encourage'' AIDS testing of their patients, particularly in areas with a high

rate of HIV infection.

The CDC said that hospitals should encourage more HIV testing because large

numbers of people are unaware that they are infected and as a result do not

receive potentially beneficial health care.

The report stresses, however, that no testing should be performed without

the patient's consent or without proper counseling.

The proposals will stand for public comment over the next month, with final

recommendations due in November.

The draft guidelines appear to be an attempt by the administration to

pre-empt a call from some congressional conservatives for mandatory testing of

all hosptial patients, with or without their consent. That move, backed by Rep.

William E. Dannemeyer, R-Calif., and Sen. Jesse Helms, R-N.C., is based on the

belief that health-care workers have a right to know the HIV status of patients

to take steps to prevent transmission of the virus.

In testimony Thursday before the House Health and Environment subcommittee,

CDC Director William Roper said, however, that the purpose of the new

recommendations was not to help doctors take greater precautions with infected

patients. Under existing federal recommendations calling for ``universal

precautions,'' Roper said, doctors already should be exercising extreme caution

in treating every patient. Instead, he stressed that the purpose of the

guidelines is to ensure better care for all patients.

``This is something that should be done for positive reasons, not negative

reasons,'' he said. ``In 1991 people need to know whether they are HIV

infected. ... For their own benefit people need to be tested when they come

in.''

The proposals were greeted with suspicion by advocates on both sides of the

debate over mandatory testing. At the hearing, Dannemeyer said he was concerned

about the CDC's insistence that testing be conducted only with the patient's

consent. If patients refused to be tested, he said, that could lead to

physicians operating on patients without the physicians knowing whether the

patient was HIV positive. This, he said, would allow ``civil rights of the

infected to take precedence over the rights of the uninfected'' to protect

themselves.

On the other hand, some opponents of mandatory testing wondered whether the

guidelines contained strong enough protections against the test results being

used for other purposes.

``If this testing is being done for the patients' good, I want to know what

steps are being planned to provide health care, protect health insurance and

get pharmaceuticals to these patients,'' said Rep. Henry A. Waxman, D-Calif.,

chairman of the subcommittee. ``Without these steps it is a charade that this

is for their own good.''

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