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?