We are proud to announce that Governor Paterson, on July 30th, signed into law historic HIV testing legislation, which amends New York State’s public health law to allow patients undergoing rapid testing for HIV to give informed consent orally (instead of in writing) and will require physicians in all health care settings routinely to offer an HIV test to persons between 13 and 64 years old. Harlem United worked very hard on this legislation and was instrumental in arriving at this compromise.
While this legislation falls short of a true opt-out approach to HIV screening in New York, we are confident that it will advance our efforts to make HIV screening a routine part of care, most particularly with a required offer of an HIV-related test in all health care settings. In addition to the “required offer” provision, the legislation will:
The legislation brings New York State closer to the Centers for Disease Control and Prevention’s (CDC) 2006 HIV testing guidelines. Twenty states required separate, signed consent before the 2006 recommendations were issued. To date, 19 states have changed their laws to be more compatible with CDC’s recommendations for oral or written informed consent that may be incorporated into a general consent for medical care. Legislation is pending in Pennsylvania (to eliminate requirements for written consent, as well as Michigan and Massachusetts. Although New York’s legislation removes requirements for written consent specifically for rapid tests it also permits the required written consent to be incorporated into the general medical consent, with a space adjacent to the signature specifically reserved for written declination of HIV testing, intended to streamline the process.
Routinely Conduct, Promote, and Ensure Access to HIV Testing
Harlem United implements a comprehensive model of care that includes HIV testing; treatment and education; primary medical care; substance use counseling; mental health services; and a range of expressive therapies. We are proud that we deliver evidence-based, outcomes-driven, comprehensive, and medically-necessary care in a cost-effective and supportive setting.
Kali, Harlem United's Senior Director of Federal Policy, joins us to remind us all why it's important that we know our HIV status, and just as important that the public health system actively encourage us to get tested.
Be prepared. This is the motto for the Boy Scouts of America and is one of the many things that they got right. Being prepared means taking the time to anticipate what lies ahead. Using all of the information that you have available, making your best effort to plan for the unexpected and avoid potential harms. These core principles have been applied toward many an educational endeavor, construction project, and trip across the state line or even overseas. When it comes to sexual health, how important is knowing your HIV status?
Speaking strictly to the basics, you need to know four things to make a decision about becoming sexually active.
For this reason, getting to know your HIV status should be accessible, economical, and accurate. Fortunately, HIV screening technology continues to improve - making the time you wait for your result shorter, the result of your HIV test more reliable, and the tests' ability to diagnose the virus in your system more sensitive. And, fortunately, organizations such as the Sexuality Information and Education Council of the United States (SIEC-US) continue to repudiate abstinence-only-untilmarriage programs that are proven ineffective for more than half of those who acquire HIV every year. Age-appropriate and comprehensive sex education provides maturing adolescents with the information that they need to make healthy decisions. All these things add up to a less intimidating testing experience with accurate information that you can use to make decisions about your health - almost immediately.
June 27, 2010 marks the 17th annual commemoration of National HIV Testing Day (NHTD) established by the National Association of People with AIDS (NAPWA) in 1996. Each year, those living with and concerned about HIV in the United States urge their friends, loved ones, and communities to “Take the Test. Take Control.” According to the Centers for Disease Control approximately one-quarter (or 280,000 to 350,000) of the more than 1.1 million people living with HIV/AIDS in the United States aren’t aware that they have HIV. These individuals unknowingly drive more than half of the estimated 56,000 new cases of HIV that are diagnosed each year.
Around 40% individuals that are diagnosed with HIV each year progress to an AIDS diagnosis within one year; approximately 5% of them will die within one month. “The evidence is clear. Routine HIV screening in clinical settings helps to avert new HIV infections and saves lives,” says Patrick McGovern, President & CEO of Harlem United Community AIDS Center, Inc. “New York State is currently working to remove longstanding barriers faced by individuals who want to know their status. Everyone should receive an HIV test regardless of their ability to pay for it or whether their health care provider believes they are at risk.”
Less than one year ago, Department of Health and Human Services Secretary Kathleen Sebelius announced an expansion of Medicare preventive coverage for HIV screening for beneficiaries who are at increased risk, including women who are pregnant and Medicare beneficiaries of any age who voluntarily request the service. This decision was supported by the U.S. Preventive Services Task Force (USPSTF) which scored subjective risk based testing as an “A”; the Secretary has discretion to expand access to any preventive services with a USPSTF score of “A” or “B”. The USPSTF maintains that the evidence is insufficient to support coverage of routine HIV screening. The CDC asserts that HIV testing should be routinely offered in clinical settings on an opt-out basis to all persons ages 13 – 64. Both the USPSTF and the CDC are under the auspices of the Department of Health and Human Services.
Senator Kirsten Gillibrand, Congressman Joe Crowley, and Congresswoman Maxine Waters each have legislation that will expand access to and reimbursement for routine HIV screening. Community advocates continue to urge legislators to co-sponsor the bills and move them forward, but little progress has been made to date. Early access to routine screening is highly associated with improved opportunities for improved health outcomes and reduced health disparities and HIV transmission for newly identified HIV-positive individuals. In commemoration of National HIV Testing Day, Harlem United is releasing its’ updated white paper (HIV Testing Policy) urging greater access to routine HIV screening in clinical settings for all persons between the ages of 13 and 64 and targeted HIV testing to populations at greatest risk.
Harlem United, founded in 1998, provides a full range of medical, social, and supportive services to predominantly African-American and Latino individuals living with HIV/AIDS, whose diagnoses are often complicated by addiction, mental illness, and homelessness. Harlem United’s prevention program employs a bifurcated strategy to educate the Harlem community about their HIV status. One track targets HIV testing to populations that are disproportionately at-risk for HIV, while a second track offers HIV screening and other preventive services block by block to persons who may be at risk but don’t know it.
Harlem United’s Senior Director of Federal Policy Participates in Panel Discussion with Former President Bill Clinton on World AIDS Day
Kali Lindsey, Harlem United’s Senior Director of Federal Policy, participated in the Clinton Foundation’s “Awareness, Access, Action: The Global and Domestic State of AIDS” panel discussion. The Foundation’s goal was to discuss the current state of H.I.V/AIDS and take the opportunity to discuss next steps. The panel included former President Clinton, Founder of the William J. Clinton Foundation. “It was so important to hear one of the greatest leaders of our time support universal access to HIV screening, comprehensive sex education, quality and affordable care, and a steadfast commitment to research for all at risk or living with HIV/AIDS both in the United States and throughout the world” said Lindsey.
The panel was moderated by Stephen Lewis, Co-Director, AIDS-Free World. Other participants included Dr. Wafaa El-Sadr, Director, International Center for AIDS Care and Treatment Programs, C. Virginia Fields, President & CEO, National Black Leadership Commission on AIDS, Lee Bollinger, President, Columbia University and Linda P. Fried, Dean, Mailman School of Public Health.
Pictured from left to right: Stephen Lewis, President William J. Clinton; Wafaa El-Sadr; C. Virginia Fields, and Kali Lindsey