March 14th 2009
For the first 25 years of the AIDS epidemic, HIV testing was treated differently from all other types of medical diagnostic testing. Formal pretest and posttest counseling was required, and patients had to give written informed consent before being tested. The need for testing was focused primarily on assessment of risk, which required the taking of a detailed sexual and drug use history for which few clinicians had the time, training, or inclination. The rationale for this particular form of “HIV exceptionalism” was mostly historical, dating back to times when concerns about stigma; discrimination; and loss of insurance, jobs, or housing outweighed any modest benefit that might have been derived from early medical care.