Behavioral Risk Factor Surveillance System Data
I used 2004, 2005, and 2006 data from the BRFSS, which is an ongoing cross-sectional telephone survey of the adult household population conducted throughout the calendar year by state health departments with technical assistance from the CDC. BRFSS data are collected in the 50 states, the District of Columbia, Puerto Rico, the US Virgin Islands, and Guam. With the exception of the 3 territories, a disproportionate stratified sample design is used in selecting BRFSS state-level samples. I limited my analysis to observations drawn from New York State and the comparison states described earlier. The BRFSS has been described in further detail elsewhere.13
How Do Partner Services Specialists Approach Working With Minors
In New York State, minors are able to get certain sexual and reproductive health services, including STD/HIV testing and STD treatment, without their parent/guardians consent. In order to protect the minors confidentiality, Partner Services staff work directly with minors, rather than their parent/guardian. If a minor specifically indicates that they want their parent contacted, Partner Services staff will do so.
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How Do I Know If I Have Hiv
The only way to know for sure if you have HIV is to get tested. You cant tell if you have HIV just by the way you feel, because most people who get HIV dont have any symptoms for years.
Testing is a good idea if youve had unprotected sex or if your partner tests positive for HIV. You should also get tested if youve shared needles with anybody . If youre pregnant, get tested for HIV at your first prenatal visit.
Luckily, HIV testing is pretty easy and painless. The best part about getting tested for HIV? Once you get it over with, it can really put your mind at ease. And if you DO have HIV, its best to find out right away so you can take medicines to help you stay healthy and lower your chances of spreading HIV to others.
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Change Comes To New York
After decades of debate, in 2010 the New York State legislature voted overwhelmingly to modify the states legal framework for HIV testing the assembly voted 97 to 0, the senate 42 to 10. The result was a carefully crafted compromise. The statute required a mandatory offering of testing to people aged 13 to 64 years in hospitals, emergency departments, and primary care settings. Rapid HIV testing could be conducted using oral consent except in jails and prisons. Consent for testing could be integrated into general consent as long as a specific part of the form provided the clear option to decline the HIV test. It is of singular importance that once consent had been given it was to be considered durable and could be terminated only when a patient explicitly sought to withdraw it.31
Although this statute finally permitted New York State to move forward, the long-fought controversy was not over. Patrick McGovern, the chief executive officer of Harlem United, declared in 2010,
New Yorks debate on HIV testing . . . has been passionate and sometimes contentious . . . while this legislation falls short on a true opt out approach, the required offer of HIV testing in all primary care settings foretells an end to the current practice of segregated and stigmatized HIV testing.32
Gay Mens Health Crisis, by contrast, underscored that it had protected written informed consent under challenging political circumstances:
For Carrie, a new battle
Appendix C: Hiv Transmission Risk
This appendix is condensed from a more detailed technical report, HIV Transmission Risk: A Summary of the EvidenceFootnote 3 which synthesises the scientific evidence on the risk of HIV transmission through sexual activities, injection and other drug use, and mother-to-child transmission. Over 200 references formed the basis of the review, based on a search of the literature for the period between 2001 and March 2012 Footnote 4. The findings from this large body of evidence demonstrated the difficulties inherent in quantifying the risk of HIV transmission, in part due to the role of behavioural and biological co-factors, including viral load and the presence of co-infections, in increasing or decreasing the risk of transmission.
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New Legislation Removes Barrier To Routine Hiv Testing In Washington
On March 21, Washington State removed a barrier to routine HIV screening as Governor Jay Inslee signed Senate Bill 6580 into law, removing exceptional consent for HIV testing.
Governor Inslee signs SB6580 into law.
Thirty years ago, HIV was a terrifying new disease that was swiftly destroying the health and lives of those it infected. Fear, misinformation, and stigma surrounded the condition. At times, people were tested for HIV without their permission or knowledge, test results were shared without consent, and if infected, people lost jobs, homes, friends, and family.
To protect people, many states, including Washington, passed laws requiring specific exceptional consent before people could be tested for HIV.
Advances in the testing, treatment, and prevention of HIV have since transformed the disease into a condition managed in ways similar to other chronic health concerns. These advances in care and treatment of HIV and new laws protecting health information have decreased the need for exceptional consent laws.
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What Happens If My Test Is Positive
If you test positive for HIV, it is important to remember that with treatment you can live a long, healthy life. In fact, with early treatment, people with HIV can live about as long as people that are not infected.
A team approach will help you get the medical care and support that you need. Start by talking to your doctor or the counselor or social worker at the testing site. He or she can help you with suggestions on how to talk to your parents or guardians and how to find a health care provider whos an HIV specialist. By starting treatment as soon as possible, you can stay healthy and learn to live well with HIV.
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Does Hiv Always Show Up On Testing
No, if someone was recently infected, it might not show up with testing. How quickly HIV shows up on testing depends on the type of test done:
- Testing that looks for the virus itself can find HIV 728 days after infection.
- Testing that looks for HIV antibodies can find HIV antibodies 312 weeks after infection.
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Hiv Patient Cured Herself Without Treatment Study Suggests
New York doctors would be able to test patients for HIV without their explicit consent under a measure that advocates say would boost detection rates but which opponents argue is invasive and doesnt confront the issue.
The bill, sponsored by state Sen. Brad Hoylman and awaiting review in the Senate Health Committee, would put the onus on patients to read signs in their doctors offices informing them that they could be tested.
Current law requires that testing be offered to anyone between ages 13 and 62, but proponents of Hoylmans bill say doctors often avoid asking that question due to its awkward nature and because of time crunches in packed hospital and clinic waiting rooms.
Ive known plenty of people who didnt get tested but wished they had, because they not only may have unknowingly passed the virus on, but their well-being suffered, too, said Hoylman. Its better to know your HIV status.
Although the plan is well-intentioned, its a shortsighted solution to a much more complicated problem, argued Dr. Jeffrey Birnbaum, of SUNY Downstate Medical Center. Theres no data to prove that removing consent will fix the problem.
Birnbaum said the existing law should be sufficient so long as doctors are willing to ask the tough questions.
Doctors are saying this is too time consuming, too much of an inconvenience but theyll talk about smoking cigarettes, obesity, diet and hypertension, he said. These are issues that also take time.
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Planning For Hiv Testing
Providing extended counselling, while preferred, may act as a barrier to testing for both the care provider and the testing client. The considerable resources and time required to conduct extensive risk assessments and pre- and post-test counselling have limited the ability of care providers to offer HIV testing. Behaviour-based risk assessments may also deter individuals from accessing testing, as such practices may involve revealing sensitive personal information. Both providers and clients may feel uncomfortable discussing such topics and, consequently, may avoid testing. The result is “missed opportunities” to diagnose those unaware of their HIV infection and link them with the treatment, care and support they need.
Providing sufficient information and supportive resources in conjunction with HIV testing does not necessarily require expertise in counselling or therapy. The level of support required in any given testing situation is highly dependent on the type of test and the testing client. While some clients may require comprehensive counselling, others may only need an abbreviated discussion supplemented with information resources such as brochures or websites.
Where Can I Go For Hiv Testing
You can get tested for HIV and other STDs at your doctors office, a community health clinic, the health department, or your local Planned Parenthood health center. You might want to get your HIV test at a place that also has HIV counseling .
You can either get an anonymous or confidential HIV test, depending on the laws in the state that you live in. Confidential testing means your name is on the test, and the results go in your medical records. Your doctors and insurance company may also see the results. If you test positive, your results are sent to your local health department so they know the rates of HIV in your area. But your results are protected by privacy laws, so nobody else can see them without your permission.
Anonymous testing means your name isnt on the test. Youll get an ID number that youll use to find out your results. Your results wont go in your medical records, and they wont be sent to your insurance company or the health department youre the only one who will know them.
STD testing, including HIV testing, isnt usually automatically part of your regular checkup or gynecologist exam you have to ask for it directly. Be honest with your nurse or doctor so they can help you figure out what tests are best for you. Dont be embarrassed: your doctor is there to help, not to judge.
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Do Health Care Professionals Ever Have An Obligation To Warn A Third Party About A Clients Hiv Status
A counselor or physician may learn that a client is engaging in unsafe sex without having disclosed his or her HIV-positive status to the partner. Many people have asked whether there is a legal basis to breach client or patient confidentiality under these circumstances. It is the AIDS Law Projects view that there is no clear justification for such a breach of confidentiality under New Hampshire law. Providers and consumers alike, however, should be aware that the case law in this area is still developing and remains unresolved. For a legal opinion on how to handle a particular situation, a professional should consult with a supervisor or lawyer.
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Does New Hampshire Have A Law Governing Consent For Hiv Testing
Yes, New Hampshire has a statute mandating consent for an HIV test, except in certain cases which are enumerated later. A physician, licensed nurse practitioner, employee of a health care facility, or employee of a blood bank, may administer an HIV test when the patient has provided his/her consent .
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Making Hiv Testing Routine
The new law does not do away with consent for HIV testing, but it removes the extra consent that was required, making the level of consent the same as it is for other serious diseases.
Medical systems and health care providers will now be able to routinely test for HIV without having to create extra documentation. Removing barriers to HIV testing allows more people to get tested, know their HIV status, and, if infected, get the treatment and care they need.
Appendix D: Natural History Of Hiv Infection
Human immunodeficiency virus is a retrovirus that infects the cells of the immune system. It is transmitted via exposure to body fluids that contain lymphocytes or free infectious viral particles . The routes of infection are: unprotected sexual intercourse, sharing of injection-drug use equipment and from an HIV-infected mother to her unborn child. Although rare, HIV can also be transmitted through an occupational exposure such as a needlestick injury or other event where blood to blood exposure could occur. All blood and blood products used in Canadian healthcare settings now undergo extensive screening for HIV prior to use, so new infections related to their use have been virtually eliminated .
The virus can enter the body through unprotected mucous membranes where cells may become infected with HIV . The presence of a sexually transmitted infection can enhance HIV transmission because of lesions and/or an increased number of lymphocytes. Using a needle contaminated with HIV-infected blood deposits the virus directly into the blood system, where infection of lymphocytes will occur. Transmission from mother to child can take place in utero, during delivery through exposure to the mother’s blood or vaginal secretions, and through breast milk . Seroconversion occurs when an individual changes from being HIV antibody negative to HIV antibody positive.
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Linkage To Prevention And Care
HIV testing is an important entry point for people into other services, such as HIV care, treatment, and prevention, as well as other services such as harm reduction and housing.
For people who test HIV positive, attempts should be made to ensure they are linked to, engaged in, and retained in HIV care and treatment, as well as to ensure they are linked to information and services related to prevention, to help avoid the onward transmission of HIV.
For people who test HIV negative, but may continue to be at risk of acquiring HIV, attempts should be made to ensure that they are linked to prevention services, such as pre-exposure prophylaxis and risk-reduction counselling, and repeat testing.
State Of Maryland Law And Consent For Hiv Testing
The State of Maryland law regarding consent requirements for HIV testing changed on July 1, 2008. The requirement to use the States informed consent document for HIV testing performed in a health care facility was revised. Use of the State form is not required if there is documentation in the medical record that informed consent was obtained from the individual who was asked to have HIV testing. Documentation in the medical record must state that the individual tested received pre and post-test counseling and was informed she/he had the right to refuse HIV testing without penalty.
The State HIV testing form is still available to clinicians and researchers. The Organization has determined that researchers who conduct research that involves HIV testing have the following two options to meet State requirements for documentation of testing.
Questions regarding the requirements for documentation of HIV testing should be directed to the Office of Human Subjects Research.
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Testing And Informed Consent
In the United States, HIV testing is governed by a range of federal and state laws, common law principles, constitutional provisions, and various codes of ethics. State laws vary widely in the degree of protection provided. The concept of informed consent, achieved through the process of physician-patient communication, is a legal and ethical obligation spelled out by statute and case law in every state. Informed consent is a legal concept, not a medical concept, and it is central to values of individual autonomy and dignity. Informed consent is characterized by a process of communication between a patient and physician that results in the patient’s authorization or agreement to undergo a specific medical intervention. Unlike testing for most other infectious diseases, testing for HIV involves possible risks, benefits, and consequences that may not be apparent to the patient.
Catie Resources For Service Providers
References
Harrigan M.
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Appendix A: Ethical And Professional Considerations
Policy concerning the ethical and professional roles and responsibilities of care providers is informed by the providers’ respective institutional code of ethics as well as the professional colleges under which they are governed.
The following is designed to complement, not supersede, existing codes of conduct or jurisdictional health policies and regulations or any applicable laws and regulations of the jurisdiction.