Mandatory Testing

[alisenjafi]

In some NY papers there is a buzz on this:
Federal Policy Calling for More H.I.V. Testing Poses a Unique Challenge in New York

Chang W. Lee/The New York Times
Riley Aponte, a health center worker, with a patient swabbing for an oral test for H.I.V. last week in the Bronx.


By RICHARD PÉREZ-PEÑA
Published: October 2, 2006
When it comes to H.I.V. and AIDS — the epidemic and its politics — New York has always looked different from the rest of the country. It has the nation’s highest rates of infection and illness, an unusual range of public and private services for those affected, and some of the biggest and best-organized advocacy groups.

Yet New York closely mirrors the national epidemic in some distressing ways, including this: About one of every four new H.I.V. diagnoses comes when the patient is found already to have AIDS. That means that in those cases, the infection went not only untreated, but undetected for a decade, on average.

Less than two weeks ago, the federal Centers for Disease Control and Prevention adopted a new, more aggressive policy on H.I.V. testing, saying that it should become a routine part of doctor visits. The agency and its supporters argue that finding more hidden infections would save lives, getting people into treatment earlier and persuading them to change their sexual behavior and reduce the spread of the virus.

That change, however, poses a political challenge in New York, where a state law passed in the 1980’s to protect the rights of people with H.I.V. and AIDS makes it impossible to carry out the new federal guidelines, which are voluntary.

While advocates agree that too few people are tested now, and that the C.D.C. recommendations will inform a continuing debate about the state law, people on all sides say there is no sign that the new federal policy would change things in New York.

The debate turns on ideas about civil liberties that are balanced a little differently in New York than in most of the country, and on widely differing theories about why millions of people who should be tested are not.

If this dispute lacks the fierce tone of past arguments about AIDS laws, experts say it remains more heated in New York than just about anywhere else. “We are still the epicenter of the epidemic,” said Dr. Marjorie Hill, interim executive director of Gay Men’s Health Crisis.

Since December, New York City’s health commissioner, Thomas R. Frieden, has made a serious push to change the state law, but he has made little headway in Albany. The Pataki administration has not taken sides, before or after the new federal guidelines. Advocacy groups that strenuously oppose Dr. Frieden, along with key lawmakers, say that nothing they have heard from him or the C.D.C. has altered their views — at least, not yet.

“What they’re recommending would require a significant change in New York law, and I am opposed to weakening the protections we have,” said Assemblyman Richard N. Gottfried, a Manhattan Democrat who is chairman of his house’s health committee.

The Senate’s health committee chairman, Kemp Hannon, a Republican from Nassau County, said he was open to arguments that the law should change, but cautiously so — in other words, he stands where he did all along. “I want to at least explore it and see where we can go,” he said.

New York law requires that a doctor or anyone else ordering an H.I.V. test must first have the patient read and sign an “informed consent” form, explaining the test and the patient’s rights, separate from the general consent forms often used to authorize a range of medical tests.

The law says that before the form is signed, the person ordering the test must provide “an explanation of the nature of AIDS and H.I.V.-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 H.I.V. infection.”

If a patient tests positive, the person who delivers that news is required to provide “counseling or referrals for counseling” on the emotional effects of the diagnosis, the discrimination that could result, and the need to change sexual practices, among other areas.

A dozen or so states — experts disagree on the number — require specific, informed consent for H.I.V. testing; the others do not. Adding the required counseling before and after the test makes New York’s law one of the most stringent in the country.

The new C.D.C. guidelines tell doctors and other medical professionals that all adults and adolescents should be tested, and that people in high-risk groups should be tested once a year or more.

They say that health care providers should inform patients that the tests will be done, not ask their permission, though patients can still refuse, and that there should be no requirements for separate written consent or counseling.

Advocates of people with AIDS lobbied hard for the state law two decades ago, at a time when medical science offered little in the way of treatment. They argued that testing exposed people to severe discrimination, and that fear of testing without consent could actually dissuade people from seeing doctors. Such arguments held little sway in most states, but they carried the day in New York.

Public health officials who support the C.D.C. recommendations contend that things are different today, with medications keeping the virus in check for many years. They also say that the stigma of infection is less of a concern, a claim that advocates dispute.

A central question is why so many people still are not tested — even in New York City, where awareness of the disease is high and testing is widely available, as is treatment, even for those who cannot pay.

Both supporters and opponents of changing the state law say that too many doctors simply do not suggest testing to their patients.

Dr. Frieden and others argue that doctors cannot or will not take the time to take all the steps required by New York law to test their patients. “They have a huge number of things that they’re supposed to cover,” he said, while pressure from insurers to see more patients means that “they’re scrunching down to seven or eight minutes for a single clinical encounter.”

Those who oppose changing the law insist that informed consent is not a serious barrier, especially since the State Department of Health produced a simplified form last year.

The problem, they say, is that doctors are uncomfortable raising the subject — another sign of the stigma involved.

“I am an African-American woman in New York City,” part of a population at high risk, Dr. Hill said, and yet, “I have never had a provider ask me, would I like to take an H.I.V. test.”

Defenders of the current state law say that the way testing is handled is crucial.

“The C.D.C. recommendations might lead to more people being tested, but is that going to get them connected with a system of care?” said Julie Davids, executive director of the Community H.I.V./AIDS Mobilization Project. “That connection has to be made quickly and sensitively, or you’ll lose them, and they won’t get treatment.”

The other side says that sensitivity matters, but that testing matters more — after all, a person who is not tested is guaranteed not to be treated. Dr. Frieden said studies show that people who learn that they are H.I.V.-positive reduce behavior that could spread the virus.

“The more people who know their status, the fewer new infections you’re going to get,” he said. “For God’s sake, people are getting sick and dying, and they don’t have to. They’re spreading H.I.V. when they wouldn’t if they knew.”

[randym431]

Absolutely!!!!!
who was it that said knowlege is power?   

[Iggy]

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[bear60]

Well, I agree that if a large number of people test positive that the system will be overwealmed and not able to handle them all. But is that a reason NOT to test.  I dont think so.  Remember what it was like in the beginning.......there was NOTHING available in terms of treatment or support or clinics. Now, at least the knowledge exists to deal with it.

[Jnm594]

"This does not mean I don't agree with mandatory testing (nor am I necessarily in favor) but I wish there was simultaneous legislation that stipulated mandatory care given to those who tested poz and instruction on how to receive it when they are given their diagnosis."

I'm with you on this one!

[wellington]

I felt a little guilty when I voted on this one because I have a very oppositional reaction to authority. Mandatory testing has the appearance of giving up some control. However, I do see considerable value in everyone being tested. While it might overwhelm the system initially, in time the influx of newly diagnosed should swing government spending in a more supportive manner - at least in theory, one hopes it would. It is perhaps a little idealistic to think that we might all care for our fellow human beings, but being pozitive has altered me permanently toward that end.

[Cliff]

To me there is a difference between wanting everyone to be tested and making testing for HIV mandatory.  Yes, I think everyone should be tested for HIV (routinely).  No, I do not think the government should have the authority to force everyone to get tested (routinely).

[sally]

I think all pregnant women should undergo mandatory testing because if they know their child might be infected with HIV, they can reduce the chance of infection to as little as 5% by following various drug options and pre- and post-natal procedures. I can't remember the name of a woman who's been in the news off and on, is HIV+ and refused to have her daughter tested even as she grew older and became more and more debilitated by the disease. The woman was and is an "HIV-causes-AIDS" denier to this day and, in my opinion, condemned her own child to a painful death due to her moronic stubborness and narcissism. I don't remember why the child wasn't removed from the home to a place where she could be treated for the disease. If that's not at the extremity of child abuse, I don't know what is. I have very personal reasons for my extreme anger with this woman. She doesn't even have the grace to shut up and stop spreading disinformation about HIV . What a (FILL IN BLANK) . . . However,

I don' t think non-pregnant adults should be subject to mandatory testing because if the information is leaked (we have no privacy anymore), there can be severe repercussions relating to work, health insurance, and family and social relationships. Educating people about safe sex, needle exchange and other preventative measures can't be stressed enough. Finally, people who have been educated and still take risks need to take the larger part of the responsibility if they become infected.

[Ann]

Hi Sally,

I don't agree with your "pregnant women should undergo mandatory testing but not the general population" idea. Women shouldn't have to give up rights that others enjoy just because they're pregnant. If you're worried about confidentiality, doesn't that worry extend to pregnant women, their children and families too?

By the way, I don't believe in mandatory testing. What I believe in is the extinction of the stigma that stops so many from testing. I believe most people would test voluntarily if there wasn't that big millstone of stigma and prejudice chained to hiv.

Just sayin'....

Ann

[wellington]

I guess that's my point exactly, Ann. If more people were to be tested, the stigma stands to be radically affected.

[alisenjafi]

. I believe most people would test voluntarily if there wasn't that big millstone of stigma and prejudice chained to hiv.

This brings up what I feel is the crux of the problem- not the stigma  but the fact that just because I am a str8 man who  likes a little man tail doesn't make me gay. See this is where I think the problem lies.  Since I don't own a PSB cd how can I possibly get HIV? The guy whom I am sure gave me the gift was a Canadian sailor. I am sure he thought he was uninfected and didn't own anything from the PSB !
I have also been with a number of Viet Nam vets who also have no inkling on safe sex and why should they , they don't practice with their wives. Thus they are ignorant of what is going around besides this .
Thanks for those who chimed in , btw when should I close this vote?
Johnny

[whizzer]

I am in favor of broad mandatory HIV testing for several reasons.

1)  I think that being required to be tested would be in and of itself an educational experience for most people.  It would say to everyone, "you are enough at risk of contracting HIV that the powers-that-be think you should be tested periodically". 

2)  It would pick up a whole lot of undiagnosed HIV.  Early detection is better than later detection.  People who know they're infected generally alter their behavior so as not to infect others.

3)  As more people outside the traditionally viewed risk groups are diagnosed, I think the stigma associated with HIV will be reduced.

[Eldon]

Hello Alisenjafi , it is Eldon.

When you look at this decision from an "overall" perspective, It is a positive thing. Why? Simply because, there are unnumbered amounts of people walking around in this world (not only the US) not knowing of their HIV status which is subsequently affecting others without knowledge of it.

It is better to know rather than to not know and end up in the hospital with PCP. It will curb the infection rate in our populations. As of today, because of the reluctance of some family physicians, now they are trying to delay the CDC's mandatory testing.

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=40282

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