Because knowing one’s HIV status is vital to HIV prevention and treatment, the Centers for Disease Control and Prevention (CDC) and the Delaware Division of Public Health recommend routine opt-out HIV screening for everyone over age 13 in health care settings. This website provides information to health care providers on the status of Delaware law regarding routine opt-out HIV testing, as well as tools for implementing routine opt-out HIV testing in health care settings. Testing is important for many reasons:

The Delaware HIV Consortium's Toolkit for Implementing Routine HIV Testing in Health Care Settings contains a wealth of information and resources for health care providers, including linkages to over 30 websites and PDF documents. The linkages may contain similar basic information, additional specific information, varying formats, and valuable resources for different purposes and situations. To help navigate the toolkit, print this 4-page "Roadmap" for a brief summary of each linkage, its contents, and page length.

Every year, an estimated 56,300 Americans are infected with HIV/AIDS and approximately 18,000 people die due to complications of AIDS (HIV Testing, 2009). The Centers for Disease Control and Prevention (CDC) estimates that more than one million people are now living with HIV in the United States and one out of five (21%) of them do not know they are infected. 53% of all new infections are transmitted by the 21% that do not yet know they have HIV – and do not perceive themselves as having been at risk and do not seek testing. While there have been great strides in HIV treatment and public education since the early 1980s, helping patients realize their risks for HIV infection continues to be a challenge for health care professionals.

Linking those with HIV to medical intervention as soon as possible in the disease process is vital to reduce morbidity and mortality, reduce transmission and improve quality of life. Studies show that people that are aware they have HIV also change their behavior to reduce the risk of HIV transmission to others (CDC, 2006). The CDC recommends routine opt-out HIV screening for all adults aged 13-64 in health care settings. Delaware Division of Public Health recommends routine testing of anyone over the age of 13 – in order to not neglect the sexual health needs of Delaware’s senior population.

One of the President Obama’s top HIV/AIDS policy priorities has been the development and implementation of a National HIV/AIDS Strategy (NHAS), released July 13, 2010. The three primary goals of the NHAS are:

1. to reduce HIV incidence,
2. to increase access to care and optimize health outcomes, and
3. to reduce the HIV-related health disparities.

The Delaware HIV Consortium is committed to achieving the NHAS goals in Delaware by providing health care providers with the resources they need to effectively implement routine HIV testing in order to help:

It is our hope at the Consortium and the Division of Public Health that, through these resources, health care providers can effectively and efficiently offer routine HIV testing to their patients.

This section provides access to links including the latest CDC Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health Care Settings, additional recommendation information from the CDC, and information from the AIDS Education and Training Center (AETC).

Information in this section can be found on current Delaware law in regards to HIV testing in health care settings. Additionally, information is provided on potential changes that may occur if the Delaware legislature adopts the full CDC’s recommendations for routine opt-out HIV testing.

Current HIV testing laws in Delaware are codified under Delaware Code Title 16. Chapter 7. Sexually Transmitted Diseases and Chapter 12 Informed Consent and Confidentiality. Subchapter I. HIV Related Test. In 2009, Delaware adopted the full CDC recommendations for pregnant women only.

Current law can be found here:
Chapter 7: Sexually Transmitted Diseases
Chapter 12: Informed Consent and Confidentiality. Subchapter I. HIV Related Test

Additional changes to the code have been drafted in bill form in 2010 by the State of Delaware Division of Public Health for the adoption of routine opt-out testing in health care settings for all persons 13 through 64. Besides recommending full adoption of the CDC recommendations, the changes codify all of the requirements under a single chapter—Chapter 7. The draft bill will be introduced to the State legislature after it re-convenes in January 2012.

The draft bill defines routine opt-out testing and outlines consent requirements to read “...that the general consent for medical care shall encompass testing for HIV and that testing may be performed as a part of routine care unless it is declined and that the declination is noted in the medical record. A separate consent for HIV testing is not required.” The draft language also modifies the definition of “Informed Consent” by eliminating the extensive pre-test counseling requirements of opt-in testing. The new consent language states that the person being tested, or the legal guardian of that person, should be informed “ …both verbally and in writing, to an extent reasonably comprehensive to general lay understanding, of the nature of the proposed testing and of the risks and alternatives to testing which a reasonable person would consider material to the decision whether or not to undergo testing.” Both of these modifications help eliminate the unnecessary paperwork and extensive counseling requirements of opt-in testing, making it easier for medical providers to offer routine HIV testing.

Last, the draft bill adds language mandating a required offer of HIV testing of pregnant women in their first and third trimester, as well as at intake into labor and delivery if the results of previous tests are not available or documented in the patient’s chart—requirements stricter than those in current law. These standardized “offers” further improve chances of eliminating mother to child transmission during or at birth or through breastfeeding (Delaware HIV Consortium Policy Committee and Planning Council, 2010).

This section provides information to health care providers on the identification and diagnosis of HIV infection, as well as facts and statistics on HIV in the United States.