Make HIV Testing More Accessible
Page Contents
The Goal
Modernizing HIV testing laws will enable more people to get tested and know their status. This will prevent hundreds of new HIV infections and deaths from AIDS each year.
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The Barrier
Current public health law hinders doctors from incorporating HIV testing into routine medical care. Unlike testing for other treatable conditions, an HIV test is made less accessible because of inflexible, outdated rules that discourage voluntary testing. Current law also limits the availability of HIV testing in non-clinical and community settings.
Current requirements that discourage routine use of HIV testing include:
- Separate written informed consent
- Unlike testing for other treatable conditions, HIV testing requires doctors and patients to fill out separate written informed consent documents. The process contributes to stigma and discourages physicians from offering voluntary testing to their patients.
- Extensive, mandated pre-test counseling for each patient, regardless of need or desire of persons getting tested
- The timing and content of HIV counseling is one-size-fits-all and inflexible. Update the minimum requirements for informed consent.
How patients suffer:
- Many physicians, especially primary care and
emergency department physicians, do not offer HIV testing as part of routine
medical care. As a result, each year in NYC more than 1,000 people first find
out they are HIV-positive when they are already sick with AIDS. They did not
receive the care they needed to stay healthy and many unknowingly spread HIV
in their community.
- HIV-positive patients who do not know their status miss opportunities to seek and receive effective care, and get sick and die sooner. They are also unaware of the need to change risky behaviors to protect their partners.
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There is a better way
The law should be changed to make HIV testing more accessible:
- Change a sole requirement for written consent forms to include the option of documented oral informed consent, as is already allowed in most states in the country. Testing will continue to be completely voluntary. Anonymous testing will still be available.
- Consent would be noted by providers in patient medical records
- Update requirements for mandatory pre-test counseling; strengthen requirements for post-test counseling following a positive HIV test
- Require the offer of linkage to care to all patients who are HIV+
How patients benefit:
- HIV testing will still only be done with informed
consent
- More rapid detection of infection and options for
treatment will decrease both illness and spread of HIV
- Patients can choose to get linked to care earlier and
stay healthier longer
- Post-test counseling for patients who test positive
for HIV (and high-risk negatives) will continue. Information will continue to
be available for all who request it. Counseling will never be denied to
anyone, but will not be mandated.
- By modernizing HIV testing laws, we can help assure that limited resources will be focused on newly diagnosed patients, who need care most
Because more physicians will offer HIV testing to patients as part of regular care, more patients will know their HIV status. They will then have the option to enter care sooner so they can live longer, healthier lives. This will likely also diminish the stigma associated with HIV/AIDS. Patients’ informed consent and right to anonymous testing will continue to be protected by law as it always has been.
Taken together, and along with the comprehensive approach the Health Department, medical providers, and community organizations are implementing, the proposed changes to current public health law will reduce the number of people who first find out they are HIV-positive once they are sick from AIDS by more than half, from 1,000 to less than 500 per year. By reducing the number of people who are diagnosed late in their illness, hundreds of new HIV infections and deaths from AIDS can be prevented each year.
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