would you like an HIV test with that?
Article 27-F in the New York State Public Health Law is The AIDS Confidentiality Law. The Article currently outlines legislation regarding HIV testing including pre and post- test counseling, reporting to local and state public health officials, and latitude given officials to contact care providers and patients.
Current law provides that HIV testing is an opt-in form of medical care, meaning simply that the individual being tested has the right to refuse testing and that health care professionals need not offer a test as a requirement of law. Should an individual request an HIV test, the individual performing the test is required by Article 27-F to provide pre-test "counseling". This counseling is (at least):
We have, in recent years, seen an increase in the incidence of infection in African American and Latino communities, women, the elderly, and an overall disregard for safer sex practices guidelines set forth by countless community based groups. However, through testing initiatives and outreach, we are seeing a decrease in proportion of positives to negatives. Translated: those who are at greatest risk just aren't coming out to get tested. Is it possible that the opt-in approach to testing has run it's course? Could it be that compulsory HIV testing is the next step in helping to identify positives in communities that aren't responsive to the outreach and testing initiatives? Could the extra caution given to testing for HIV actually be feeding into the stigma?
Have we reached a point in the 25 year epidemic that HIV testing should be performed side-by-side with screens to rule out cancer, diabetes, gonorrhea, and sickle cell?
New York City Commissioner of Health and Mental Hygiene, Dr. Thomas Frieden thinks so.
Frieden has recently proposed amendments to Article 27-F eliminating the need for written informed consent and all pre-test counseling, and allowing public health officers to act as de-facto case managers while increasing penalties for violating HIV confidentiality or failing to secure verbal consent. The goals of Frieden's proposal are clear: increase likelihood of patients to have an HIV test and using that information to improve linkage to care.
If the medical community and society at large is ever to matriculate into a way of seeing HIV infection as a long-term, manageable, preventable, communicable illness, isn't testing the logical starting point?
Could it be possible that by opposing the use of Frieden's verbal consent screening amendment, it is those closest to the fight against HIV who are acting to the detriment of further dismantling HIV stigma ?
At the risk of alienating myself from a community that has twenty plus years experience on me, I must come out in support of the amendments' verbal only consent intentions. In the worst case scenario, we may find that the epidemic isn't as much the equal opportunistic virus that we had thought. In the best case scenario, we will reach communities that have been unresponsive to convention outreach methods (and resultantly develop more efficient outreach models, preventive tactics, and treatment approaches).
However, I do believe that it may be necessary to re-evaluate the need for public health officials to replace an already efficient case management system (COBRA). Let's take this one step at a time: first comes compulsory testing (with a significant increase in the awareness of health care professionals and willingness of institutions to adopt the added expense of on-site rapid testing), and then we can call big brother to tell us what to do with the outcomes.
Current law provides that HIV testing is an opt-in form of medical care, meaning simply that the individual being tested has the right to refuse testing and that health care professionals need not offer a test as a requirement of law. Should an individual request an HIV test, the individual performing the test is required by Article 27-F to provide pre-test "counseling". This counseling is (at least):
In July of 2005, HIV testing underwent a streamlining which eliminated the need for pre-testing counseling to be administered verbally . Anyone that has received an HIV test since that time is aware that the pre-test portion consists of the tester handing you an information sheet and asking if you have any questions about the information therein. It is at this time the tester receives written informed consent to administer the HIV test. The entire document is two pages long. Most of the above items are to ensure that the identity and privacy of the individual being tested are protected at all passes, and to provide a feeling of security to those that would otherwise not receive a test due to personal and social stigmas attached to both HIV and the individuals that request/receive HIV testing.[...]an explanation of the test, including its purpose, the meaning of its results, and the benefits of early diagnosis and medical intervention; an explanation of the procedures to be followed, including that the test is voluntary, that consent may be withdrawn at any time, and a statement advising the subject that anonymous testing is available; an explanation of the confidentiality protections afforded confidential HIV related information under this article, including the circumstances under which and classes of persons to whom disclosure of such information may be required, authorized or permitted under this article or in accordance with other provisions of law or regulation; [...]an explanation of the nature of AIDS and HIV related illness, information about discrimination problems that disclosure of the test result could cause and legal protections against such discrimination, and information about behavior known to pose risks for transmission and contraction of HIV infection; [...]an opportunity to remain anonymous and to provide written, informed consent through use of a coded system with no linking of individual identity to the test request or results. A health care provider who is not authorized by the commissioner to provide HIV related tests on an anonymous basis shall refer a person who requests an anonymous test to a test site which does provide anonymous testing.
We have, in recent years, seen an increase in the incidence of infection in African American and Latino communities, women, the elderly, and an overall disregard for safer sex practices guidelines set forth by countless community based groups. However, through testing initiatives and outreach, we are seeing a decrease in proportion of positives to negatives. Translated: those who are at greatest risk just aren't coming out to get tested. Is it possible that the opt-in approach to testing has run it's course? Could it be that compulsory HIV testing is the next step in helping to identify positives in communities that aren't responsive to the outreach and testing initiatives? Could the extra caution given to testing for HIV actually be feeding into the stigma?
Have we reached a point in the 25 year epidemic that HIV testing should be performed side-by-side with screens to rule out cancer, diabetes, gonorrhea, and sickle cell?
New York City Commissioner of Health and Mental Hygiene, Dr. Thomas Frieden thinks so.
Frieden has recently proposed amendments to Article 27-F eliminating the need for written informed consent and all pre-test counseling, and allowing public health officers to act as de-facto case managers while increasing penalties for violating HIV confidentiality or failing to secure verbal consent. The goals of Frieden's proposal are clear: increase likelihood of patients to have an HIV test and using that information to improve linkage to care.
If the medical community and society at large is ever to matriculate into a way of seeing HIV infection as a long-term, manageable, preventable, communicable illness, isn't testing the logical starting point?
Could it be possible that by opposing the use of Frieden's verbal consent screening amendment, it is those closest to the fight against HIV who are acting to the detriment of further dismantling HIV stigma ?
At the risk of alienating myself from a community that has twenty plus years experience on me, I must come out in support of the amendments' verbal only consent intentions. In the worst case scenario, we may find that the epidemic isn't as much the equal opportunistic virus that we had thought. In the best case scenario, we will reach communities that have been unresponsive to convention outreach methods (and resultantly develop more efficient outreach models, preventive tactics, and treatment approaches).
However, I do believe that it may be necessary to re-evaluate the need for public health officials to replace an already efficient case management system (COBRA). Let's take this one step at a time: first comes compulsory testing (with a significant increase in the awareness of health care professionals and willingness of institutions to adopt the added expense of on-site rapid testing), and then we can call big brother to tell us what to do with the outcomes.
posted by brian. at 2:46 PM
