For the Record: HIV testing, Confidentiality, and the MIT Medical Center

by Alo Basu

As students become increasingly aware of HIV as a reality among young
people of diverse backgrounds and behaviors, we are concerned with how
and where to get tested. Testing demands great caution because HIV
status has been used as a basis for discrimination in matters of
housing, employment, and insurance. There is a widespread social
stigma attached to HIV positive status because AIDS is still perceived
as a gay disease, and also because of lingering ignorance as to how
the virus is transmitted.
	Because of society's irresponsibility in educating people
about the facts of HIV, this stigma is often extended to anyone who
gets tested for HIV. Getting tested implies that they are engaging in
homosexual sex, promiscuous behavior, or illegal IV drug abuse.
	Because of the sensitivity that surrounds being tested for
HIV, sites that offer HIV Antibody Testing generally do so
confidentially or anonymously. Confidential test results are kept
between the medical facility and patient unless the patient gives
written consent for their release. Anonymously administered tests are
never linked to a name at all; subjects are assigned a code and their
test results are communicated along with some form of pre- and
post-test counseling and/or education, but there is no long-term
documentation of the codes and their related HIV information.
	In response to concerns voiced by patients and physicians that
outsiders might utilize HIV test results for discriminatory purposes,
the MIT Medical Department formulated a policy in 1985 which kept
students' HIV information somewhat more confidential than the rest of
their medical records. Medical records can only be viewed by MIT
Medical staff, and can only be released to outside agencies with the
written consent of the patient. From 1985 through 1994, a mark on the
outside of a student's medical record indicated whether the student's
record contained any HIV information. The HIV information itself was
kept in a separate confidential file. No outsider to the MIT Medical
Department would know how to decipher the mark or that an HIV file
even existed for the student. The contents of the HIV file were also
voluntarily releasable by the student via an additional written
consent.
	Effective January 1, 1995, the MIT Medical Department altered
its policy with regard to the confidentiality of HIV test results. HIV
test results are now included in the medical record. Dr. Mark
Goldstein, Chief of Student Health Services at MIT, says that the
change was made "in conformity with other teaching hospitals in the
Boston area." He says that, "people's attitudes toward HIV-infected
individuals have changed" over the past ten years because the practice
of getting tested is more common. He feels that the current policy
facilitates pre- and post-test counseling with the primary care
physician, and it is important that a physician know the HIV status of
a patient for the accurate diagnosis of the widespread medical
implications that HIV might have. HIV test results are still less easy
to release than the rest of the medical record. They are kept in a
file of sensitive information along with substance abuse and
psychiatric evaluations, which require another consent form to be
released. Though a piece of paper exists in the patient's file which
indicates that he or she has been tested for HIV antibodies, HIV
information is never entered into a computer database. HIV information
is still a step more confidential than the bulk of the medical record,
but outside agencies are aware that sensitive information files exist,
and may well ask and oblige students to release them.
	Despite its view that HIV status should not be used as a basis
for discrimination, the MIT Medical Department does not provide
anonymous HIV testing services. Perhaps the Medical Department should
give more credence to individual patients' capability to let their
physicians know their anonymous HIV test results. Students could then
avoid the risk of being obliged to release the information to an
employer or insurance company-discrimination in these cases is
certainly a concern. Anonymous test results, as with any other
confidential information, are never matched to a name, so they can
never be used to aid discrimination, nor can they be subpoenaed by a
court of law, viewed, or released by the guardians of minor students.
	There are several sites in the Boston/Cambridge area that
offer free, anonymous HIV testing as well as pre- and post-test
education and counseling, to which the Medical Department and Tracy
Desovich, Health Educator for Students, refers students who would
prefer to take advantage of this additional level of security. There
is no way of knowing for sure how many MIT students are taking
advantage of free, anonymous testing off campus, so it is no surprise
that our Medical Department feels no compulsion to provide the
service. However, it is certainly no secret that off-campus community
clinics that offer anonymous HIV testing are reaching the limits of
their capacity to serve the public. It is no secret either that many
members of this public are MIT students. Perhaps, for these reasons,
the MIT Medical Department should consider offering anonymous HIV
testing as an alternative to its current system so that it may better
serve all those under its care. HIV testing is now a critical element
of modern health care. Why does a modern health care institution such
as MIT Medical discourage so many of its patients from getting tested
there?  


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