May 11, 2007
TESTING BILLS GALORE
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More tests needed — but how? |
Lawmakers in Albany have prepared more than 40 bills related to HIV/AIDS for consideration in the six weeks left of this year's regular legislative session. At least three of the measures related to HIV testing and informed consent are under close consideration by rank-and-file members, committee chairs and leaders.
NYC Health Commissioner Thomas Frieden's proposal for elimination of written consent, pre-test and post-test counseling, and for broad distribution of HIV-related individual medical data is included in a bill introduced by (notorious) Assembly Member Nettie Mayersohn.
Another measure would eliminate written consent, strip down pre-test counseling and require a referral to medical care, while rejecting Frieden's radical proposal to transfer private medical data. It has been introduced by Assembly Member Daryl Towns.
And AIDS groups from around the state met with Assembly Members on Tuesday in support of "universal offer" legislation being prepared by Assembly Health Committee Chair Dick Gottfried and supported in the Senate by Senator Tom Duane.
The "universal offer" bill, currently being circulated for sponsorship, would require physicians, physician assistants, nurse practitioners and midwives to offer HIV tests to all patients aged 13 to 64 receiving diagnostic health care in non-emergency situations.
Strong support for "universal offer"
A diverse group of New York's AIDS service providers and advocates came up to Albany Tuesday to advocate for the measure, including representatives from the Asian and Pacific Islander Coalition on HIV/AIDS (APICHA), the Federation of Protestant Welfare Agencies (FPWA), Gay Men's Health Crisis (GMHC), Hispanic AIDS Forum, Housing Works, the Legal Action Center, the New York AIDS Coalition (NYAC), and the Ryan Health Center.
The newly-drafted legislation differs from bills that would eliminate pre-test counseling and written consent. It was developed as a result of hearings held in New York City last December and recent pilot studies that demonstrated to lawmakers that written informed consent and pre-/post-test counseling were not real barriers to expanded testing.
Instead, testimony and data demonstrated that doctors simply are not offering the test to their patients, either because of discomfort talking about sex and drug use or a perception that the patients they see are not at risk.
The NYC Health and Hospitals Corp. found last year that doubling the number of HIV tests offered resulted in a doubling of the number of "new" HIV diagnoses — using current provisions for simple, postcard-size written consents to testing.
And a recent survey by the New York AIDS Coalition found acceptance rates of 90 percent or more among providers who routinely offered HIV tests to their patients.
The "universal offer" measure is designed (see below) to address these issues — and it has won support from front-line providers and communities-of-color groups as the best way to expand testing while respecting those being tested.
"I think the fact that these folks are working on the frontlines and working in the communities hit hardest by HIV really made an impact on legislators," said Charles Long of Housing Works, who was part of Tuesday's visits. "We didn't have to raise our voices — where we come from spoke loud enough for them to listen hard."
Universal offer — what it's all about
The aim of Gottfried's bill is to increase HIV testing and to overcome the common difficulties health care providers face in bringing up the topic of HIV: Many are reluctant to bring up what they anticipate will be a difficult topic; many wrongly assume that a patient is not a risk for exposure to HIV; many believe that a patient may believe that the offering of testing means that the practitioner is making assumptions about the patient's behavior.
And patients may believe that the offering of an HIV-related test reflects negatively on them; that can be an obstacle to agreeing to be tested or to accept other services. Many patients do not perceive themselves to be at risk for HIV, or may not initiate testing discussions themselves because they believe doing so requires them to disclose their risk behaviors.
According to its sponsors, a "universal offer" of an HIV test should help overcome all these factors — and help simplify, destigmatize, and routinize the offering of HIV testing, while ensuring full respect for patients through simple, postcard-sized written consent.
Gottfried's office is working with Assembly Members on cosponsorship, and has already won the support of many influential lawmakers with track records of accomplishment on HIV/AIDS. We'll keep you posted on the progress of all three bills in upcoming issues of the Update — to get involved in advocacy on the issue, email long2@housingworks.org.